Remacle Marc
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Louvain at Mont-Godinne, Yvoir, Belgium.
Curr Opin Otolaryngol Head Neck Surg. 2008 Dec;16(6):511-5. doi: 10.1097/moo.0b013e328313bb94.
There is no standard protocol for managing globus pharyngeus. Checking the recent developments in this field regularly is of paramount importance.
The commonest symptoms for which proton pump inhibitors are prescribed are globus (73%), followed by choking episodes (66%) and chronic cough (62%). Opinions remain divided about the role of upper esophageal sphincter hypertonicity in globus sensation. Upper aerodigestive tract malignancy is rare and must be excluded. Hypertrophy of the base of the tongue, heterotopic gastric mucosa, curled epiglottis, thyroid enlargement, rare benign or malignant tumors of the pharynx, excessive tension and Eagle's syndrome are possible causes. Flexible endoscopy is a frequently used examination, but there is a 'blind zone' under any upper aerodigestive tract malignancy, requiring rigid endoscopy for some indications. Barium swallow pharyngoesophagography should not be requested systematically for cancer detection. Dual-probe 24 h pH monitoring can help in the diagnosis of reflux. Impedance recording can be useful for the detection of acidic and nonacidic liquid and mist reflux events. Manometric measurements are consistent. Laryngopharyngeal symptoms, such as throat clearing, hoarseness, cough, and globus pharyngeus, are slower to resolve than esophageal symptoms. Nocturnal recovery of gastric acid secretion was demonstrated even with proton pump inhibitors. The symptoms disappeared with an additional H2 receptor antagonist.
More awareness is required for patients complaining of globus pharyngeus.
对于咽异感症的管理尚无标准方案。定期了解该领域的最新进展至关重要。
质子泵抑制剂最常被用于治疗的症状是咽异感（73%），其次是噎食发作（66%）和慢性咳嗽（62%）。关于食管上括约肌张力亢进在咽异感中的作用，观点仍存在分歧。上消化道恶性肿瘤较为罕见，必须予以排除。舌根肥大、异位胃黏膜、会厌卷曲、甲状腺肿大、咽部罕见的良性或恶性肿瘤、过度紧张和鹰综合征均可能是病因。可弯曲内镜检查是常用的检查方法，但在上消化道任何恶性肿瘤下方都存在一个“盲区”，某些情况下需要硬性内镜检查。不应为了癌症检测而系统性地要求进行吞钡食管造影检查。双探头24小时pH监测有助于反流的诊断。阻抗记录对于检测酸性和非酸性液体及雾气反流事件可能有用。测压测量结果具有一致性。咽喉部症状，如清嗓、声音嘶哑、咳嗽和咽异感症，比食管症状缓解得更慢。即使使用质子泵抑制剂，也证实了夜间胃酸分泌会恢复。加用H2受体拮抗剂后症状消失。
对于主诉有咽异感症的患者，需要提高认识。
