長期喉嚨痛的診治

Diagnosis and Treatment of Long-term Sore Throat

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 6卷4期 (2009/08) Pp. 281-290

https://doi.org/10.6200/TCMJ.2009.6.4.04

摘要

目的：長期喉嚨痛臨床上並不少見，診斷不易明確，需考慮鼻及鼻竇炎、喉部病灶、舌根潰瘍、舌炎、慢性肥厚性扁桃腺炎、舌根扁桃腫大或咽喉逆流等，於此分享本院的治療經驗，期待能對臨床有所助益。方法：回顧本院自2006年7月到2007年11月間，作者門診中所有以長期喉嚨痛為主訴之病患，為了與其他急性或亞急性疾病鑑別，特選擇症狀期在3個月以上者，共計56名。在排除放射線治療後所致之黏膜炎1名後，尚餘55名（男28，27），平均年齡47.8歲，81.8%(45 of 55)症狀期在3年以內。以問診及理學檢查找出可能的病因，可輔以軟式纖維鼻咽內視鏡檢或硬式喉內視鏡檢。結果：除了12名失去了追蹤，4名尚在治療中外，共計39名症狀已經消失，治療期間3.0±2.1（平均值±標準差）週，其中30名合併抗胃酸逆流療法，19名合併類固醇鼻噴劑及抗組織胺，僅2名曾於治療初期給予非類固醇性抗發炎劑。結論：診治長期的喉嚨痛時，不應該盲目地給予症狀治療，當考慮到各個鼻咽喉病灶之間的關係，方可擬定正確的治療計畫。

關鍵字

喉嚨痛 ； 抗胃酸逆流療法 ； 類固醇鼻噴劑 ； 抗組織胺

並列摘要

Long-term sore throats are not unusual; however, their management is a challenge. Rhinosinusitis, laryngeal lesions, tongue-base ulceration, glossitis, chronic hypertrophic tonsillitis, lingual tonsillar hypertrophy, or laryngopharyngeal reflux may be impressed. Herein, we reported our clinical experience. Methods: Between July 2006 and November 2007, 56 patients with a long-term sore throat were retrospectively collected. To exclude cases with acute disease, only cases with symptoms that had lasted at least 3 months were enrolled. After one patient with radiation-induced mucositis was excluded, a total of 55 patients, made up of 28 males and 27 females were enrolled. Their age was averaged 47.8 years. Among them, 81.8% (45 out of 55) presented with a sore throat that had lasted for no more than three years. The etiology was studied by history taking and by physical examination with or without flexible fiberoptic nasopharyngoscopy or rigid laryngoscopy. Results: Twelve patients were lost to the study, four are still under treatment, and the remaining 39 were cured of their symptoms in 3.0±2.1 weeks (average ± standard deviation). Among these 39 patients, 30 received anti-reflux therapy, 19 received glucocorticosteroid nasal spray and an antihistamine, and two simply received one week of non-steroid anti-inflammatory drugs. Conclusion: Symptom control is not invariably recommended. The lesions present in the nose, pharynx and/or larynx should be treated, too.

並列關鍵字

sore throat ； anti-reflux therapy ； glucocorticosteroid nasal spray ； antihistamine