軟式鼻咽喉內視鏡診斷及治療慢性咳嗽

Role of the Flexible Fiberoptic Nasopharyngolaryngoscope in Chronic Cough

陳建志(Jiann-Jy Chen) ； 陳瑞昌(Juei-Chang Chen) ； 林炯堃(John-K. Lin)

《北市醫學雜誌》 5卷2期 (2008/04) Pp. 240-250

https://doi.org/10.6200/TCMJ.2008.5.2.08

摘要

目的：慢性咳嗽定義為持續3個禮拜以上的咳嗽，是胸腔科、家庭醫學科及耳鼻喉科門診常見的主訴。軟式纖維鼻咽喉內視鏡檢對耳鼻喉科醫師而言是一種相當有用的方法，本研究利用它於輔助此類病患的檢查分析。方法：目標為2006年1月到2006年6月間，由責任暨第一作者在桃園及新竹地區共1家區域及2家地區醫院的門診中，所有慢性咳嗽者共計158名。排除氣喘、服用血管收縮素轉化酶抑制劑之病史、Sjögren症候群、耳垢栓塞、胸部X光或身體理學檢查顯示肺部病灶者後，尚有145名（女87，男58），平均年齡51歲（13~81歲）。初診時咳嗽頻率每小時5~20次者佔73.1%，症狀時間從3週到超過20年，74.5%是1年以內，輔以經鼻腔軟式纖維鼻咽喉內視鏡檢。結果：與咳嗽有關的發現可以分成5種：鼻涕倒流(60.7%)、聲門病灶(60.7%)、口咽腫塊(13.1%)、疑似咽喉胃酸逆流(13.1%)及喉部腫瘤(0.7%)。僅1種病灶者(51.0%)以聲門病灶或鼻涕倒流為多，合併2種病灶者(42.1%)以鼻涕倒流合併聲門病灶最多，合併3種病灶者(4.1%)以鼻涕倒流合併聲門病灶及口咽腫塊最多；少數(2.8%)無任何發現。給予對應的治療後，起初2週內，76.6%症狀改善，12.4%沒有改善，11.0%失去追蹤。目前已有65.5%治癒，20.0%尚在治療中，14.5%失去追蹤。結論：慢性咳嗽的病因複雜，除了病史詢問、身體理學檢查及胸部X光外，建議輔以軟式纖維鼻咽喉內視鏡檢評估，這是一個簡易且經濟的檢查，可以發現細微病灶及觀察喉部動態，進而給予特定的治療及安排必要的進一步檢查。由於無法診斷出鼻腔咽喉以外的病灶，若治療失敗或診斷未明則需要影像學或其他科的協助。

關鍵字

慢性咳嗽 ； 軟式纖維鼻咽喉內視鏡檢

並列摘要

Background and Purpose: Chronic cough is defined as cough for more than 3 weeks. It is a common chief complaint in out-patent clinic of chest, family medicine and otorhinolaryngology department. In this prospective study, we examined chronic cough patients with flexible fiberoptic nasopharyngolaryngo scope. Methods: From January 2006 to June 2006, an otorhinolaryngologist performed history taking, chest X ray, and physical examination for patients with chronic cough at a regional hospital and 2 local hospitals in Tao-Yuan and Hsin-Chu County. The subjects with a history of asthma, taking angiotensin converting enzyme inhibitors, Sjögren syndrome, cerumen impaction, abnormal chest auscultation, or abnormal chest X ray were excluded from the survey. A total of 145 patients, including 87 females and 58 males were enrolled. The average age was 51 (13-81) years. The frequency of cough at initial visit was 10~20 times per hour in 40.7%, and 5~10 times per hour in 32.4%. The duration of symptom was 3 weeks to over 2 decades (≤1 year: 74.5%). They were examined with flexible fiberoptic nasop haryngolaryngoscope. Results: The findings were classified into 5 categories: posterior nasal drip (PND) (60.7%), glottic lesion (GL) (60.7%), oropharyngeal mass (OPM) (13.1%), suspected laryngopharyngeal acid reflux (13.1%), and laryngeal neoplasm (0.7%). GL and PND both predominated in the only-1-category group (51.0%), PND+GL in the combined-2-category group (42.1%), and PND+GL+OPM in the combined-3-category group (4.1%). Negative finding was noted in 2.8%. In 2 weeks after specific therapy, 76.6% improved, 12.4% did not improve, and 11.0% was lost. Up to date, 65.5% was cured, 20.0% was being treated, and 14.5% was lost. Conclusion: Chronic cough is of complicate causes. For the fine lesions and laryngeal dynamics, flexible fiberoptic nasopharyngolaryngoscope is an easy and useful tool. We think it is complementary to history taking, physical examination, and chest X ray. Then, specific therapies or other necessary exams will be planned. Lesions outside nasal cavities, pharynx and larynx cannot be ruled out by flexible fiberoptic nasopharyn golaryngoscopy. We need help from image study or other departments' specialists if initial therapy fail or cause can not be found.

並列關鍵字

chronic cough ； flexible fiberoptic nasopharyngolaryngoscopy