咽部溃疡致鼻咽闭锁1例

患者 ,女 ,38岁。于 1 998年 3月无明显诱因出现鼻咽部疼痛、异物感 ,鼻呼吸或吞咽时疼痛加重 ,被迫张口呼吸 ,无鼻出血、流脓涕 ,亦无昏迷、恶心及其他症状。在外院检查发现鼻咽部溃疡 ,经活检确诊为“溃疡型咽结核” ,在抗痨治疗的同时 ,为促进愈合 ,刮除溃疡表面坏死组织 ,上述症状缓解 ,鼻呼吸明显改善。半年后鼻呼吸受阻逐渐加重 ,因条件所限未就诊 ;2年后不能用鼻呼吸 ,于 2 0 0 0年 5月 2 6日来我院就诊。检查 :鼻腔通气受阻 ,被动张口呼吸。擤鼻不能 ,闭塞性鼻音 ,嗅觉减退。见软腭与咽后壁粘连 ,悬雍垂居中 ,变短 ,以大弯钳从前鼻…     

以咽痛为主要症状的心肌梗死误诊1例

患者，男，81岁，发作性咽痛4年。每次发作咽部疼痛难忍，可放射到颈后，持续1～2h，无药物可抑制。疼痛剧烈时想解大便，解后疼痛部分缓解。伴咽喉有痰，不易咳出，饮水后好转。无吞咽困难、吞咽痛，无发热、咳嗽、咯血，无胸闷、心悸及心前区疼痛。多次在外院诊断为“慢性咽炎”，并服用过20多种药（如消炎片、华素片、喉症丸等）和连续服过2．5个月中药，均无效。近2个月发作咽痛次数增多，每1～2d发作1次，每次持续3～4h，疼痛程度加重，伴嗓音沙哑。既往有高血压史8年，平时服波依定5mg，每天1次，控制血压。为进一步查明咽痛原因遂于2006年1月9日收住我科。     

以咽痛为首发症状的狂犬病二例

例1 男,11岁。因咽痛1 h 于2005年12月3日9:00来我科门诊就诊。检查:神志清楚,一般状况可;咽部黏膜及双扁桃体均不充血;间接喉镜检查:会厌无充血、肿胀,甲状腺触诊无异常。血常规:白细胞12.6×10~9/L,中性0.86。诊断:咽痛原因待查。以生理盐水500 ml+青霉素640万 U静滴后患者自行回家。当日16:00复诊,自诉症状无好转,且有加重,并感觉呼吸困难。咽喉部复查,体征仍为阴性;详问病史,否认有误吸异物史及颈部、咽部外伤史;听诊双肺呼     

以咽痛为主诉的心绞痛误诊1例

患者 ,男 ,5 8岁。因咽痛反复发作 4个月就诊。4个月前活动后 (体力劳动或快步走 )出现咽痛 ,诊断为“咽炎” ,给头孢氨苄口服 ,草珊瑚及西瓜霜含片含服 ,咽部微波热凝及超声雾化吸入 ,均无效 ,疼痛逐渐加重 ,遂来我院耳鼻咽喉科就诊。检查 :一般情况尚可 ,扁桃体不肿大 ,咽部黏膜稍充血 ,无淋巴滤泡增生。有原发性高血压史 3年 ,咽痛在体力活动后出现。 2 4h动态心电图示心肌缺血 ,无疼痛时 ,T波与ST段正常 ,V4 V6T波倒置 ,深至 0 .3～0 .4mV ,ST段呈水平下移 0 .75～ 0 .10mV。内科会诊拟诊为心绞痛。采用抗高血压和抗心绞痛药物治疗…     

以咽痛为首发症状的小脑肿瘤1例

患者 ,女 ,1 2岁。因咽痛 1个月 ,伴吞咽困难、言语含糊 5d ,于 2 0 0 1年 1 0月 1 1日收治入院。体检 :咽部亚急性充血 ,双扁桃体Ⅰ度肿大。双侧腭舌弓浅表各有单个溃疡。间接喉镜见会厌、舌根、双侧声带均有黄白色颗粒样病变 ,杓会厌襞肿胀 ,梨状窝积液 ,双侧声带内收外展受限。肝脾B超、胸片均正常。患者父亲 1 997年因右小脑血管母细胞瘤手术 ,其叔叔、姑妈均因脑肿瘤死亡 (具体情况不详 )。给予全身抗炎、抗病毒及支持治疗。第 2天检查发现会厌肿胀 ,抬举欠佳。第 4天出现抽搐两次 ,口吐白沫 ,3～ 4min缓解。检查发现伸舌困难但不偏 ,…     

《伤寒论》苦酒汤治疗难治咽部溃疡1例并文献复习

目的 报道《伤寒论》苦酒汤治疗难治咽部溃疡1例,学习苦酒汤治疗咽部溃疡的适应证候以及临床应用的具体方法。方法 回顾、总结1例苦酒汤治疗难治咽部溃疡的诊疗过程,通过数据库检索、著作阅读的方式,从苦酒汤方证、煎服法及相关现代研究方面进行文献复习。结果 苦酒汤多用于治疗少阴虚火灼咽所致咽痛、溃疡、失音。其中可以醋可代苦酒,用以解毒敛疮,鸡子白止痛润咽,半夏豁痰开痹。煎服法上多改良仲景之法,通过后下鸡子白的方法存其凉润之性。在临床上,苦酒汤可应用于急慢性咽喉炎、失音、喉源性咳嗽、梅核气以及放疗后口腔溃疡等疾病的治疗。结论 苦酒汤对治疗咽部溃疡等咽部疾病具有确切临床疗效,但其药物选用、煎服法考证及改良、机制探索均有待进一步研究。     

以咽部不适为主诉的急性心肌梗死1例

患者 ,男 ,37岁。就诊 1d前无诱因出现咽部发热、不适 ,偶有干咳 ,未治疗。就诊前 6h上述症状加重 ,在本村卫生室静脉滴注先锋霉素 ,症状无缓解 ,于 2 0 0 0年 1 1月 1 6日就诊我科。患者无自觉胸闷、憋气 ,无心前区疼痛。主诉“嗓子难受”。检查 :神志清楚 ,发声不哑 ,坐卧不安 ,咽黏膜无充血 ,扁桃体不肿大。间接喉镜下见 :会厌及声带无充血、水肿 ,活动正常。急查心电图示 :窦性心律 ,90次 /min ,Ⅱ、Ⅲ、avF、V6 9,S T段抬高 0 .0 5～0 .1 0mV ,T波直立。诊断 :急性下、后壁心肌梗死 ,收心内科治疗。　　讨论　急性心肌梗死多以心前…     

咽部骨瘤1例

患者 ,女 ,56岁 ,因咽部异物感 3个月于 1 999年 2月 2 0日入院。 3个月前无诱因出现咽部异物感 ,无疼痛 ,在外院诊为咽炎 ,并给予口服抗生素治疗 ,未见效。专科检查 :口咽部咽后壁右侧靠近腭咽弓处可见一约 2 .0 cm× 1 .5cm大小半圆形隆起的肿物 ,质硬 ,边界清 ,活动度差。颈部 CT平扫描 :右口咽后间隙环椎前示 1 .0 cm× 1 .2 cm的类圆形环状高密度灶 ,与环椎间有间隙。诊断 :口咽侧壁软组织多发钙化。2 5日在全麻鼻腔插管下行咽部肿物摘除术 ,于肿物表面作纵形切口 ,沿肿物表面剥离 ,完整取出肿物 ,见其呈白色 ,质硬 ,类圆形 ,约 1 .0 …     

以口咽部肿物并伴面神经麻痹为首发表现的伯基特淋巴瘤1例

伯基特淋巴瘤(Burkitt lymphoma,BL)是高度恶性非霍奇金淋巴瘤,多发生在儿童青少年,起病急,侵犯范围广,以颈淋巴结肿大、腹部盆腔病变、骨髓和中枢侵犯多见,发生在口咽部较为罕见,我科收治1例来源于口咽部的伯基特淋巴瘤并伴随有面神经麻痹的患儿1例,现报道如下.     

咽喉部多发性顽固性溃疡的临床分析

目的探讨咽喉部多发性、顽固性溃疡的病因及临床特征,进一步提高对本病的认识及诊断水平。方法对2009年10月~2012年10月共计47例以咽喉部溃疡为特征的病例,通过专科、实验室、影像学及病理等各种检查进行临床分析。结果诊断为咽喉结核为48.93%、白色念珠菌感染为17.02%、梅毒14.89%和人类免疫缺陷病毒感染为4.26%。结论对咽喉部多发性、顽固性溃疡应进行详细的病史询问、体格检查和专科检查,以及必要的实验室、影像学、病理学等检查,才能做出正确的诊断,避免误诊。医务工作人员需警惕职业暴露及交叉感染。     

A concha bullosa mucopyocele manifesting as migraine headaches: a case report and literature review

A concha bullosa is a common anatomic variant that represents an aerated turbinate, usually the middle turbinate. It is usually asymptomatic. When extensively pneumatized, a large concha bullosa may cause significant problems, including headache, nasal obstruction, and blockage of sinus drainage. We report a case of a large concha bullosa mucopyocele that manifested as recurring migraine headaches. It was successfully treated with surgical excision. We also review the available literature.     

Treatment of submucous cleft palate by pharyngeal flap as a primary procedure

OBJECTIVE: (a) Palatal repair is the standard surgical method for correction of velopharyngeal incompetence due to submucous cleft, but some patients may need further narrowing of velopharynx by pharyngeal flap. (b) The purpose of this study is to evaluate the efficacy of a pharyngeal flap as a single surgical procedure in the treatment of symptomatic cases. METHODS: Nine cases of symptomatic submucous cleft palate were subjected to treatment by pharyngeal flap only as a primary and single procedure after failure of speech therapy. Preoperative flexible nasopharyngoscopy was carried out for all children to determine the width of the velopharyngeal gap; the results were recorded on videotape and reviewed in the operating theatre for determination of the width of the pharyngeal flap. Postoperative follow-up by flexible nasopharyngoscopy and parent's questionnaire were used to assess the success rate. RESULTS: Follow-up flexible nasopharyngoscopy showed complete closure of the lateral ports in eight cases (89%) while one case (11%) showed incompetence. Hypernasality was improved in all cases witnessed by parent's questionnaire and this improvement was satisfactory in seven cases (78%) but not satisfactory in two cases (22%). One of the last two cases reached to satisfactory level after speech therapy, while the other case showed no further improvement. CONCLUSIONS: Speech therapy alone cannot correct hypernasality in presence of anatomical defect. Pharyngeal flap is a useful procedure monitored by flexible nasopharyngoscopy. When pharyngeal flap is used, the need for adjunctive procedure is absent.     

Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children

Objectives

The aim of this study was to assess the pharyngeal airway space (PAS) in nasal and mouth-breathing children using cone beam computed tomography (CBCT).

Methods

Volume, area, minimum axial area and linear measurements (PAS-NL, PAS-UP, PAS-OccL, PAS-UT, PAS-Bgo, PAS-ML, PAS-TP) of the pharyngeal airway of 50 children (mean age 9.16 years) were obtained from the CBCT images. The means and standard deviations were compared according to sexes (28 male and 22 female) and breathers patterns (25 nasal breathers and 25 mouth breathers).

Results

There were no statistically significant differences (p > 0.05) between all variables when compared by sexes. Comparisons between nasal and mouth breathers showed significant differences only in two linear measurements: PAS-OccL (p < 0.001) and PAS-UP (P < 0.05). Airway volume (p < 0.001), area (p < 0.001) and minimum axial area (p < 0.01) had significant differences between the groups.

Conclusions

The CBCT evaluation showed that pharyngeal airway dimensions were significantly greater in nasal-breathers than in mouth-breathers.     

顽固性咽异感症病因学与伴随症状的相关性研究

目的研究咽异感症病因与伴随症状的关系,为临床初步诊断其病因提供依据。方法315例咽异感症患者仔细询问病史、系统检查,包括胃镜检查、胃食管24 h PH值测定、男性生物有效性睾酮(bioavailable tes-tostone,Bio-T)的检查、直立试验以及男子更年期综合征10个问题问卷调查,并对伴随症状、咽异感部位进行分析总结,明确病因后进行个体化治疗。结果315例患者中,茎突综合征11例、颈椎疾病7例、变态反应性咽炎5例、鼻后滴漏综合征(PNDs)21例、阻塞性睡眠呼吸暂停低通气综合症(OSHAS)7例、精神创伤29例、恐癌16例、抑郁焦虑83例、更年期综合征42例、自主神经功能紊乱11例、甲状腺疾病3例、胃食管反流27例、喉咽反流53例。其中133例部位恒定,182例部位游走不定;192例伴失眠多梦,62例伴月经紊乱,88例伴胸闷心慌,115例伴上消化道症状。结论咽异感症病因与伴随症状具有明显相关性,有时临床上可依据咽异感症的部位及伴随症状对病因进行初步诊断。     

Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique

Treatment of symptomatic pharyngeal and esophageal strictures requires endoscopic dilatation. The Savary-Gilliard bougienage was developed by our department and has been used since 1980 for this purpose. We report our experience using this technique. The records of patients seen from January 1, 1963 to December 31, 2005, who had pharyngeal and esophageal strictures needing dilatation, were reviewed. The prevalence of different etiologies, and the incidence of complications using the Savary-Gilliard dilators were assessed. Efficiency of dilatation was assessed over a 17-year segment of this period, using number of dilatations and time intervals between dilatations until resolution of symptoms as outcome measures. Of the 2,652 pharyngeal and esophageal strictures reviewed, 90% were of organic origin (45% benign and 55% malignant stenoses), and 10% were of functional etiology. The most common etiologies were peptic strictures before the era of proton pump inhibitors, and postoperative anastomotic strictures thereafter. A total of 1,862 dilatations using the Savary-Gilliard technique were analyzed. Complication and mortality rates were 0.18 and 0.09% for benign and 4.58 and 0.81% for malignant etiologies, respectively. The number of dilatations per stricture and the time interval between different sessions were dependent on the type of strictures, varying from 1 to 23 dilatations and 7 days to 16 years, respectively. Pharyngeal and esophageal dilatations using the Savary-Gilliard technique were safe when used together with fluoroscopy. Overall, the efficiency of the dilatation procedure was good, but some types of strictures (e.g., caustic, post-surgical and/or post radiotherapy) were refractory to treatment and required repeated dilatations.     

Pharyngeal tonsil manifestation of Langerhans cells sarcoma: A case report and review of the literature

Langerhans cell sarcoma (LCS) is an extremely rare malignant disease with multi-organ involvement and a poor prognosis. LCS involvement of tonsil has not been previously reported. However, we present herein a 10-year-old Tibetan boy distressed by LCS arising on the pharyngeal tonsil. Owing to local traditions and customs, he endured a long period of treatment with traditional Tibetan medicine which provided only slight relief at best that delayed an accurate diagnosis and scientific medical treatment. Subsequently, based on CT and MRI scans, combined with pathology features positive immunophenotype for the CD1a and S-100 proteins confirmed the diagnosed of LCS. We performed a surgical resection along with a regimen of E-CHOP chemotherapy was prescribed as new protocols. As a result the patient complete remission symptoms and without relapse has been 20 months.     

咽异感症患者心理因素评析及心理干预疗效分析

目的 探讨咽异感症患者心理干预的疗效.方法 2012年1月～2012年12月对确诊为咽异感症的156例患者进行SCL-90(symptom check list-90)症状自评量表的心理状态测试,并随机分为对照组与治疗组,治疗组在对照组药物干预的基础上进行综合心理干预.结果 治疗两周后复诊患者共有130例,其中对照组69例,心理治疗组61例,总有效率分别为68.12%、93.44%,两者有统计学差异(P<0.01).结论 咽异感症患者心理干预的疗效显著,值得临床广泛应用.     

Pedunculated pleomorphic adenoma of the tongue base manifesting with dysponea. A case report

Pleomorphic adenomas of the minor salivary glands are rare. The most common site is in the palate. We have come across a case of pedunculated pleomorphic adenoma of the base of the tongue which came to us only when the tumour had caused respiratory distress.