Pharyngeal paraesthesia
Introduction
Introduction to pharyngeal paraesthesia Pharyngeal paraesthesia Chinese medicine is called plum nuclear gas. As early as the Sui Dynasty, there is a record similar to this disease, and its symptoms are like the plum nucleus blocking the throat. At present, the term "pharyngeal paraesthesia" is often used to refer to a variety of pharyngeal abnormalities other than pain, such as hallucinations, ball sensation, ant sense, etc., which is one of the main complaints frequently encountered in clinical work. Most of the patients are middle-aged, and women are more common. Because of the foreign body sensation in the throat, there are not many people who suspect that the tumor is treated. In some early stages of cancer, such as posterior ring cancer and upper esophageal cancer, there may be a foreign body sensation in the throat. Symptoms, such as lack of vigilance, easy to misdiagnose, therefore, the diagnosis of pharyngeal induction in detail to prevent missed diagnosis, misdiagnosis. basic knowledge The proportion of illness: 0.001% Susceptible population: most of the patients are middle-aged, more common in women Mode of infection: non-infectious Complications: sore throat, pharyngitis
Cause
Causes of pharyngeal paraesthesia
The pharyngeal nerve innervation is extremely rich. The sensory and motor nerves are mainly from the pharyngeal plexus of the posterior pharyngeal wall. They contain vagus, pharyngeal, accessory, and presympathetic branches. In addition, there is a second branch of the trigeminal nerve, the glossopharyngeal nerve, etc. Distributed in the pharynx, the pharynx is extremely sensitive. The diseases of many organs in the body can also cause abnormal sensation in the pharynx through the reverse and conduction of nerves. Therefore, the mechanism of pharyngeal paraesthesia is complicated, and the pathogenic factors are numerous. Factors are easy to be discovered, such as bacteria, parasites and other biological factors, physical factors such as heat and cold, current, pressure and mechanical damage and chemical factors. In addition, mental factors can also cause the disease, such as mood swings and long-term over-stress, fatigue Neurological disorders caused by such diseases, sometimes organic diseases and mental factors coexist, constitute a complex cause, can be divided into three aspects of local, systemic and mental physique.
1. Local factors
1. Pharyngeal diseases: such as various types of pharyngitis, chronic tonsillitis, tonsil stones, polyps, keratinization, cysts, scars and abscesses, tonsillitis, uvula overhang, foreign bodies of the nasopharynx, oropharynx and hypopharynx , scars, tumors, varicose veins of the tongue, cysts, tumors, styloid syndrome, pharyngeal diverticulum, etc. These pains can often be found by pharyngeal examination, but for early tongue root tumors and tonsil malignant tumors, it is often difficult to find them only by visual inspection. If you use palpation, you may feel a local hardening feeling. The microscopic mucosal erosion concealed between the pharyngeal mucosa folds, the pharyngeal sac opening at the top of the nasopharynx, the adhesion in the pharyngeal crypt, and the nasopharyngeal carcinoma developed under the mucosa, such as poor examination, are often missed. Occupation-related pharyngitis such as dusty, chemical pharyngitis is also the cause of pharyngeal paraesthesia.
2. Diseases of adjacent organs: diseases of the nose and nasopharynx such as sinusitis and nasopharyngitis. Laryngeal diseases such as laryngeal neuritis, rheumatic circumflex arthritis, epiglottic cysts, epiglottis abnormalities, laryngeal perichondritis, angioedema, pharyngeal muscles and hypopharyngeal muscle spasm. Esophageal diseases such as esophageal fistula, diverticulum, achalasia, early malignant tumors, traumatic esophagitis, reflux esophagitis, phlegm, and diaphragmatic hernia. Neck diseases such as neck lumps, fistulas, lymphadenitis, nail cysts, thyroid inflammation, tumors and other diseases such as dental disease, ear disease, cervical syndrome, glossopharyngeal neuralgia, carotid arteritis, etc., can cause this disease . Some of them believe that the diaphragmatic hernia is the most important adjacent lesion of the throat obstruction. Malcomson (1968) analyzed 440 patients who had a barium meal examination in the upper gastrointestinal tract in 7 years, of which 307 (70%) complained of a laryngeal pharyngeal obstruction. Among the patients, 104 (34%) of the patients with diaphragmatic hernia were found. After the treatment of hiatal hernia, the symptoms of throat obstruction gradually disappeared. Reflux esophagitis can cause a feeling of obstruction of the throat. Because the acidic liquid stimulates the esophagus, it can cause motor dysfunction, and the symptoms are improved or disappeared after acid treatment. Early upper esophageal cancer has a foreign body sensation or obstruction in the throat. The symptoms are more obvious when eating, but the pharyngeal sensation is opposite. Although there is a foreign body-like feeling, there is no self-consciousness when swallowing.
2. Systemic factors
1. Disorders away from organs: such as stomach and duodenitis or ulcers, stomach cancer, pyloric palsy, cholelithiasis, left heart enlargement, hypertensive heart disease, pericarditis with effusion, aortic aneurysm, refractive error, etc. Otolaryngologists are less likely to pay attention to these diseases, or do not recognize the relationship with pharyngeal paraesthesia. Malcomson (1968) performed detailed X-ray gastrointestinal barium examination on 307 patients with "Ryukyu". Among the 242 (79%) patients with positive lesions, more than half of them were away from organ diseases, of which 104 were diagnosed as deaf. 39 cases of stomach and duodenal ulcer, the rest are pyloric fistula, hypertensive heart disease, esophageal deviation, achalasia, etc., effective treatment for the primary disease, the original sputum symptoms can disappear.
2. Systemic diseases: more common in metabolic and endocrine diseases, such as vitamin deficiency, iron deficiency anemia, thyroid diseases such as hyperthyroidism or hypothyroidism, menopausal syndrome, myasthenia gravis, cervical osteoarthritis, joint stiffness and intestine Parasitic diseases. Iron deficiency anemia is closely related to pharyngeal paraesthesia. Many patients have lower serum iron content and higher unsaturated iron binding capacity. Vitamin deficiency supplementation with riboflavin and niacinamide is effective in refractory patients.
3. Mental factors
Changes in mental and emotional effects have a significant impact on the occurrence and development of pharyngeal sensations, such as neurasthenia, neurosis, schizophrenia, cancer, rickets and anxiety, and inhibition.
Medical workers explain the patient's abnormal feelings improperly or not carefully, and do not eliminate the patient's doubts or do excessive examinations and treatments, causing the patient's doubts can also lead to the original intention.
Traditional Chinese medicine attaches great importance to modality and causes disease. It is believed that "Mei nuclear gas" is caused by Qiqing stagnation, stagnation of qi stagnation in the throat or accompanied by liver and stomach disharmony. "If the nucleus is infested, it will not be swallowed, and it will not spit out. If you are in a state of depression, you will be even worse. If you are happy, you will see it lightly." This fully illustrates the role of mental factors in the disease.
Prevention
Pharyngeal paraesthesia prevention
1. The mood is comfortable, optimistic, work and rest, life is regular, the room is clean and tidy, the work is not urgent, the peace of mind and so on are the foundation of self-care, not causing the patient's mood is not good, helping them to establish confidence in treating diseases, is nursing the rules.
2. Eat light, eat less fried fatty food.
3. Exercise, regular life, and ensure sleep.
4. Relieve ideological concerns and enhance treatment confidence.
Complication
Pharyngeal paraesthesia complications Complications , sore throat, pharyngitis
Some patients feel that the pharynx has leaves, hair, thread, swelling and sputum stickiness, and some feel the neck tightness and do not dare to buckle.
Symptom
Symptoms of pharyngeal paraesthesia Common symptoms Tongue and throat burning sensation sore throat Chronic congestive lymphadenopathy
The patient can often indicate that the pharynx is between the oropharynx and the sternum, and there are more throat and pharynx. The pharynx can feel like foreign body, ant, burning, tight, stuffy, narrow, etc. Some patients I feel that there are leaves, hair, hair, hair and sputum in the throat, and some feel that the neck is tight and I dont dare to buckle. The above feeling is obvious when the patient is doing pharyngeal movement, but it is reduced or disappeared when eating. Generally, there is no pain or only mild sore throat. The symptoms often fluctuate with the patient's mood, and the abnormal feeling can be changed at any time.
In patients with pharyngeal paraesthesia, local lesions are often inconspicuous or mild. Patients with symptoms and signs should be excluded from the symptoms of various organic lesions in the pharynx. Careful examination of the nasopharynx, oropharynx, throat and neck No mucosal congestion, swelling, hyperplasia, dryness, atrophy, scarring, presence or absence of deformity, lymphadenopathy, etc.
Examine
Examination of pharyngeal paraesthesia
Check the nasopharynx, oropharynx, throat and neck for mucosal congestion, swelling, hyperplasia, dryness, atrophy, scarring, presence or absence of deformity, lymphadenopathy, etc.
Diagnosis
Diagnosis and diagnosis of pharyngeal paraesthesia
diagnosis
The cause of this disease is more complicated. You should listen carefully to the main complaint and learn more about the pathogenesis, life, working environment and possible incentives. Generally speaking, abnormal feelings caused by organic lesions often have fixed sites, while those with unknown foreign body sense are not all caused by mental factors. X-ray and esophageal barium examinations are available for patients with adjacent lesions. According to the history, symptoms, and all the data of the examination, the pharyngeal paraesthesia can be diagnosed after excluding the organic lesions hidden in the pharynx, neck, upper respiratory tract, upper digestive tract and other parts.
Differential diagnosis
Exclude organic lesions hidden in the pharynx, neck, upper respiratory tract, upper digestive tract, etc., such as throat cancer.
