反流性喉炎的临床观察

The Clinical Observation on Reflux Laryngitis

目的探讨胃食管反流病与反流性喉炎(reflux laryngitis,RL)之间的关系。方法对55例RL患者进行详细的病史采集,分别行电子喉镜、上消化道内镜、X线钡餐拍片,嗓音声学分析等检查,并给予抑酸抗反流治疗。结果RL患者多表现为咽喉部不适和异物感(89.1%)、慢性咳嗽(36.4%)、声音嘶哑(20%)、喉痛(18.2%),严重者甚至引起误吸、喉痉挛(10.9%)等症状,电子喉镜下可见杓区充血(67.3%),杓间区黏膜肿胀或肥厚形成皱襞(43.6%),声带、假声带水肿(40%),梨状窝积液(32.7%),声带后部接触性溃疡或肉芽肿(20%),声带缘下出现假性声带沟(16.4%);RL患者可出现轻度的嗓音异常,65.5%表现为紧张性发声障碍,其基频(F0)、频率微扰(jit-ter)、振幅微扰(shimmer)、及标准化噪声能量(NNE)值升高,除女性F0外,与正常组比较差异均有统计学意义(P<0.05)。经质子泵抑制剂(PPI)治疗症状体征改善或消失。结论反流性喉炎是胃食管反流病(GERD)的主要消化道外表现之一,以声门后部病变为主,质子泵抑制剂(PPI)既可以作为其治疗手段又可用作临床试验性诊断的方法。

Objective To summarize the clinical diagnosis and treatments of 55 reflux laryngitis （RL） pa- tients, and to study the relationship between gastroesophageal reflux disease （GERD） and RL. Methods The pa- tients went through the following diagnostic process consisting of the collection of medical history, laryngoscopy, gastroscope, X--ray barium meal examination, vocal evaluation, therapy of anti--acid and anti--reflux. Results The laryngeal manifestations of RL mainly consisted of laryngeal discomfort or foreign body sensation （89. 1%）, chronic cough （36.4%）, hoarseness （20%）, laryngeal pain （18.2%）, even severe aspiration or laryngismus （10. 9 %） and so on. With the laryngoscopy we could see congestion in arytenoids area （67.3 %）, swelling or pachynsis of a mueosal fold in interarytenoid area （43.6%）, edema of true or false vocal cord（40 % ）, a little dropsy staying in piriform sinus （32.7 %）, contact ulcer or granuloma on posterior extremity of a vocal cord （20%）, artificial sulcus under vocal cords （16.4%）. RL patients might have mild voice disorder, among whom 65.5 percent displayed ten- sion dysphonia. Fundamental frequency （F0）, jitter, shimmer and normalized noise energy （NNE） of RL patients increased. Compared with the controls, there were significant differences （P〈0.05） except for the F0 of female pa- tients. The manifestation and physical symptoms were improved or disappeared after the treatment with proton pump inhibitor （PPI）. Conclusion RL is one of the important manifestations of GERD out of digestive tract. Typi- cal RL manifestation is mainly a pathological process in the postero--glottis. Clinically, PPI can be used as not only a treatment but also a tentative diagnosis of RL.