Halitosis and the Tonsils
Halitosis and the Tonsils
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口臭和扁桃体
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Joseph Mickel
中科院分区：
文献类型：
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作者：
M. Ferguson;M. Aydin;Joseph Mickel
目的腭扁桃体病变所致的口臭在病因学分类上属于气道性口臭（2型）。关于扁桃体病因引起的客观口臭投诉的比例，报告各不相同，有些报告给出的数字为3%。由于它们的免疫作用，即使是健康的扁桃体通常也会有一些亚临床炎症。扁桃体隐窝系统也是上呼吸道厌氧菌活动的最理想环境。扁桃体口臭被认为主要是因为慢性干酪性扁桃体炎和扁桃体结石（扁桃体结石）。据报道，扁桃体切除术和各种隐窝溶解技术可以改善这种情况下的口臭。在这篇文章中，诊断方法和干预措施的证据进行审查。数据来源Medline检索。回顾方法研究报告的任何干预措施（医疗或手术）对扁桃体口臭的疗效包括在内，无论口臭是重点或几个措施之一。结论：关于这一主题的高质量研究不足。需要改进方法，例如，使用对照组和利用更准确的口臭检测/量化技术。实践的意义目前缺乏证据，无法得出明确的结论，但建议：（1）使用可靠的方法进行口臭诊断和扁桃体病因的确认。初步治疗，如刮舌是有用的，以排除口腔口臭。(2)扁桃体手术禁忌于：主观口臭，非扁桃体病因，或如果医疗管理解决口臭。(3)在适应症和设施允许的情况下，微创技术（如激光隐窝溶解术）可能优于成人扁桃体切除术，这可能避免全身麻醉和与扁桃体切除术相关的较高风险。
Objective Halitosis secondary to pathology of the palatine tonsils is considered airway (type 2) halitosis in the etiologic classification. Reports differ as to the proportion of objective halitosis complaints that have tonsillar etiology, with some giving this figure as 3%. Due to their immunologic role, even healthy tonsils usually possess some subclinical inflammation. The tonsil crypt system is also the most ideal environment for anaerobic bacterial activity in the upper respiratory tract. Tonsillar halitosis is thought to occur mainly because of chronic caseous tonsillitis and tonsillolithiasis (tonsil stones). Tonsillectomy and various cryptolysis techniques are reported to improve halitosis in such cases. In this article, diagnostic methods and evidence for interventions are reviewed. Data Source Medline search. Review Methods Studies reporting the efficacy of any intervention (medical or surgical) on tonsillar halitosis were included, whether halitosis was the focus or one of several measures. Conclusions There are insufficient high-quality studies on this topic. Improved methodology, for example, use of control groups and utilization of more accurate halitosis detection/quantification techniques, are required. Implications for Practice Lack of evidence currently prevents firm conclusions, but the following is recommended: (1) Use reliable methods for halitosis diagnosis and confirmation of tonsillar etiology. Initial treatment such as tongue scraping is useful to rule out oral halitosis. (2) Tonsillar procedures are contraindicated in: subjective halitosis, non-tonsillar etiology, or if medical management resolves halitosis. (3) Where indicated and where facilities permit, less invasive techniques such as laser cryptolysis may be preferable to tonsillectomy in adults, potentially avoiding general anesthetic and the higher risk associated with tonsillectomy in this group.