舌咽神经痛误诊误治分析

摘要

目的 分析舌咽神经痛(glossopharyngeal neuralgia,GPN)的误诊原因并提出防范措施.方法 结合相关文献对我院收治的2例较典型的GPN的临床资料进行回顾性分析.结果 本组患者均因咽痛反复发作长期误诊为咽喉炎、扁桃体炎、心脏病等,经纤维鼻咽喉镜、胸部X线及鼻咽CT等检查排除炎症或肿瘤疾病的影响后,行表面麻醉可见咽痛明显减轻,确诊为GPN,予卡马西平及异丙嗪等镇痛、镇静治疗后患者痊愈,随访至今未见异常.结论 GPN误诊的主要原因是疼痛部位多变及医生对本病认识不足.临床接诊咽痛患者经各种治疗后效果仍欠佳时应考虑本病可能,详细询问病史及全面检查有助于及早诊断及治疗.%Objective To analyze the cause of misdiagnosis of glossopharyngeal neuralgia in order to propose preventive measures. Methods The clinical data of two cases in our hospital with typical GPN combined with the related literature were retrospectively analyzed. Results These patients were misdiagnosed as having pharyngitis, tonsillitis, heart disease for a long time because of recurrent sore throat. After medical examinations such as fiber laryngoscope, chest X-ray and nasopharynx CT, the impact of inflammation or tumor disease were excluded. The treatment of topical anesthesia reduced the sore throat significantly, so it was finally diagnosed as GPN. The patients were cured by analgesic sedative medication such as earbamazepine and promethazine, and follow-up up to now has shown no abnormality. Conclusion Misdiagnosed cause of GPN is the changeable pain sites and lack of knowledge of the disease. GPN should be considered when the efficacy of various treatments is poor. A detailed study of medical history and across-the-board medical examinations can contribute to final diagnosis.