咽喉頭部異常感と唾液分泌障害

ON THE ABNORMAL SENSATION OF THE PHARYNGOLARYNGEAL REGION AND HYPOSALIVATION

　I．はじめに

　一口に咽喉頭部異常感（以下異常感と略す）といつてもその訴えは様々で，異物感圧迫感，腫脹感のほか乾燥感，いがらつぽさなども認められる。他方，口内乾燥症，Sjögren症候群などのsicca syndromeを中心とする唾液分泌障害例の多数に異常感が併存するのを認めている。過去10数年にわたる北村，奥田らによる唾液腺の詳細な研究を通して，唾液腺機能障害が異常感の一原因たり得ることが明らかにされたが，今回のシンポジアムに関連した異常感の総合的研究の一端としてこの関係について再検討を試みた。

　Among the patients who complain of abnormal sensations in the pharyngolaryngeal region dryness of the throat is also a common one.

　Statistical observation showed the presence of dryness of the throat and mouth was about 20% of the total sensory disorders of this region. Many patients complaining of dryness suffered, also, of cancerophobia or of other depressive conditions.

　Xerostomia and other sicca syndrome were accompanied by paresthesia of the throat and dysphagia in a large percentage of the cases.

　There was a close relationship between abnormal sensations and hyposalivation. Various tests were made to measure quantitative salivary flow. Hyposalivation was classified into 3 group:glandular, secretorily nervous and psychoneurotic. Two thirds of the total number of hyposalivation appeared to be belonging to the last type. Metacholin test showed that, among the psychoneurotic type, there were more hyperactive cases than those of any other. The majority of the glandular type seemed to fall in the normoreactive.

　A study on the innervation of the salivary glands showed a fine net-work of non-myelinated nerve fibers surrounding the acini of the gland. Sensory nerve endings in the pharynx were found in different forms and distribution according to the locality. These endings may be affected by changed conditions inflammatory or mucosal irritability caused by hyposalivation.

　The author concluded that pharyngeal paresthesia may be caused not only by local processes of the mucosa and surrounding organs such as hyposalivation and autonomic imbalance, but also, it may be brought on by other factors such as depressive psychic conditions creating a vicious circle to result in psychoneurotic reduction of salivary production.