Harabuchi Yasuaki, Kumai Takumi, Nishi Kensuke, Tanaka Ayaki, Hotta Osamu, Hagino Hitoshi, Kusuyama Toshiyuki, Mogitate Manabu, Ohno Yoshihiro, Sakakibara Akira, Araki Satsuki, Nishida Yoshinao, Shintani Tomoko, Takezawa Hiroyuki, Ito Hirofumi, Komazawa Daigo, Nishiwaki Noriko, Toritani Ryuzo, Hirahata Koichi, Marumo Satoshi
Epipharyngeal Abrasion Therapy Review Committee, Japan Society of Stomato-pharyngology, Tokyo, Japan.
Japanese Focal Inflammation Related Disease Research Group, Sendai, Japan.
JMA J. 2025 Apr 28;8(2):371-384. doi: 10.31662/jmaj.2024-0437. Epub 2025 Mar 21.
Chronic epipharyngitis is associated with a wide variety of symptoms, including local symptoms such as postnasal drip, sore throat, lump sensation of the pharynx, headache, chronic cough, nasal obstruction, tinnitus/ear fullness, chronic phlegm and dysphonia due to inflammation of the epipharynx, functional somatic symptoms such as chronic fatigue, dizziness, insomnia, brain fog, abdominal discomfort, and depression caused by dysfunction of the hypothalamus-limbic system via disturbances of vagal response and cerebrospinal fluid outflow, and distant organ symptoms such as immunoglobulin A nephropathy and palmoplantar pustulosis caused by the epipharyngeal lymphoid tissue as an etiologic organ. In the past, chronic inflammation in the epipharynx was difficult to prove by gross findings, now, direct observation of the epipharyngeal inflammation by endoscopy has become easier for the diagnosis. For the treatment of chronic epipharyngitis, epipharyngeal abrasive therapy (EAT), epipharyngeal application of a 1% zinc chloride solution intranasally or orally was popular since the 1960s, recently, endoscopic EAT (E-EAT), in which epipharynx is safely and accurately observed and abraded under clear vision using an endoscope, has been developed. The mechanisms of EAT effects can be classified into anti-inflammatory/antiviral effect, bloodletting effect, and vagus nerve stimulation effect. Recently, the effectiveness of EAT for post-acute sequelae of coronavirus disease 2019 (COVID-19), known as long COVID, has come into the limelight, and the number of patients for whom EAT is expected to increase. In 2019, the Japan Society of Stomato-pharyngology established the EAT Review Committee to accumulate evidence on the efficacy of EAT and to establish indications and techniques for its use. In this article, the EAT Review Committee outlines its symptoms, pathogenesis, and diagnosis of chronic epipharyngitis, technique of E-EAT, mechanisms of EAT effects, past reports for the efficacy of EAT, and a multicenter prospective study.
慢性上咽炎与多种症状相关，包括局部症状，如鼻后滴漏、喉咙痛、咽部异物感、头痛、慢性咳嗽、鼻塞、耳鸣/耳闷、慢性咳痰以及由于上咽炎症引起的发音障碍；功能性躯体症状，如下丘脑 - 边缘系统功能障碍通过迷走神经反应和脑脊液流出紊乱导致的慢性疲劳、头晕、失眠、脑雾、腹部不适和抑郁；以及远处器官症状，如由作为病因器官的上咽淋巴组织引起的免疫球蛋白A肾病和掌跖脓疱病。过去，上咽的慢性炎症通过肉眼检查很难证实，现在，通过内窥镜直接观察上咽炎症已使诊断变得更容易。对于慢性上咽炎的治疗，自20世纪60年代以来，上咽磨削疗法（EAT），即经鼻或口服应用1%氯化锌溶液于上咽很流行，最近，已开发出内窥镜下EAT（E - EAT），即在清晰视野下使用内窥镜对上咽进行安全准确的观察和磨削。EAT作用机制可分为抗炎/抗病毒作用、放血作用和迷走神经刺激作用。最近，EAT对2019冠状病毒病（COVID - 19）的急性后遗症，即所谓的长期新冠的有效性受到关注，预计EAT适用的患者数量会增加。2019年，日本口腔咽科学会成立了EAT审查委员会，以积累EAT疗效的证据并确立其使用的适应症和技术。在本文中，EAT审查委员会概述了慢性上咽炎的症状、发病机制、诊断、E - EAT技术、EAT作用机制、EAT疗效的既往报告以及一项多中心前瞻性研究。
