Ohno Yoshihiro
Otolaryngology, Ohno ENT Clinic, Tokyo, JPN.
Cureus. 2024 Feb 12;16(2):e54067. doi: 10.7759/cureus.54067. eCollection 2024 Feb.
Background Chronic epipharyngitis causes postnasal drip, pharyngeal pain, pharyngeal discomfort, headache, and shoulder stiffness. Additionally, autonomic nervous system symptoms such as dizziness, general fatigue, and sleeplessness may occur. It can also contribute to the development of focal diseases. Although epipharyngeal abrasive therapy (EAT) is effective for chronic epipharyngitis involving the abrasion of the epipharynx with a zinc chloride solution, there is a lack of clear diagnostic criteria, and treatment outcomes are rarely reported. Methodology A classification of the severity of chronic epipharyngitis was attempted in 154 cases based on nasopharyngeal endoscopic findings, with a subsequent examination of treatment outcomes using EAT. Diagnosis of chronic epipharyngitis involved identifying redness, swelling, postnasal drip, and crusting of the epipharyngeal mucosa. Severity classification relied on a four-point scale measuring the degree of redness and swelling, with additional points assigned for the presence of postnasal drip and crusting. This classification also served as a criterion for judging treatment effectiveness. The prevalence and improvement rate of black spots and granular changes were assessed through nasopharyngeal endoscopy with narrow-band imaging. Subjective symptoms were evaluated using before and after treatment questionnaires, employing a four-point scale for symptoms commonly associated with chronic epipharyngitis (headache, postnasal drip, nasal obstruction, pharyngeal discomfort, pharyngeal pain, shoulder stiffness, tinnitus, ear fullness, dizziness, cough, and sputum). A 10-point numerical rating scale (NRS) was used to assess the physical condition. Results Following EAT, the severity of nasopharyngeal endoscopic findings notably improved, with a 76.0% (117/154) improvement rate (remarkable improvement: 19.5% (30), improvement: 56.5% (87)). The improvement rate for the chief complaint reached 85.7% (132/154), demonstrating significant enhancement in the score for each symptom. NRS scores also improved at a rate of 76.0% (117/154). A significant correlation was observed between the improvement in local findings and chief complaints. The prevalence of black spots and granular changes before EAT was 83.8% (129/154) and 64.3% (99/154), exhibiting improvement rates of 65.9% (87/132) and 54.8% (57/104), respectively. Conclusions Nasopharyngeal endoscopy proves valuable for diagnosing and assessing the severity of chronic epipharyngitis, as well as evaluating treatment effectiveness. The findings indicate that EAT is an effective treatment for chronic epipharyngitis, with improvements in local findings correlating with enhancements in the chief complaint. This underscores the importance of employing aggressive EAT in managing patients with chronic epipharyngitis.
背景 慢性咽炎可导致鼻后滴漏、咽痛、咽部不适、头痛和肩部僵硬。此外，还可能出现自主神经系统症状，如头晕、全身乏力和失眠。它还可能促使局部疾病的发生。尽管咽上磨蚀疗法（EAT）对涉及用氯化锌溶液磨蚀咽上部位的慢性咽炎有效，但缺乏明确的诊断标准，且很少有治疗结果的报道。方法 基于鼻咽内镜检查结果，对154例慢性咽炎患者的严重程度进行分类，随后使用EAT检查治疗结果。慢性咽炎的诊断包括识别咽上黏膜的发红、肿胀、鼻后滴漏和结痂。严重程度分类依据一个四点量表来衡量发红和肿胀的程度，鼻后滴漏和结痂的存在会额外加分。该分类也作为判断治疗效果的标准。通过窄带成像鼻咽内镜评估黑点和颗粒状改变的发生率及改善率。使用治疗前后问卷评估主观症状，采用四点量表评估与慢性咽炎常见相关的症状（头痛、鼻后滴漏、鼻塞、咽部不适、咽痛、肩部僵硬、耳鸣、耳闷、头晕、咳嗽和咳痰）。使用10分数字评定量表（NRS）评估身体状况。结果 EAT治疗后，鼻咽内镜检查结果的严重程度显著改善，改善率为76.0%（117/154）（显著改善：19.5%（30例），改善：56.5%（87例））。主要症状的改善率达到85.7%（132/154），各症状评分均有显著提高。NRS评分也以76.0%（117/154）的比例得到改善。局部检查结果的改善与主要症状之间存在显著相关性。EAT治疗前黑点和颗粒状改变的发生率分别为83.8%（129/154）和64.3%（99/154），改善率分别为65.9%（87/132）和54.8%（57/104）。结论 鼻咽内镜检查对于诊断和评估慢性咽炎的严重程度以及评估治疗效果具有重要价值。研究结果表明，EAT是治疗慢性咽炎的有效方法，局部检查结果的改善与主要症状的改善相关。这凸显了在慢性咽炎患者管理中积极采用EAT的重要性。
