重新定义耳鼻咽喉头颈外科的疾病分类与教学

文献信息

中文摘要

背景： 耳鼻咽喉头颈外科的疾病分类仍根植于18世纪和19世纪的解剖学框架，早于现代组织病理学和病理生理学。这种以解剖学驱动的分类方法可能无法充分涵盖跨越解剖边界的疾病，例如喉咽反流病、前庭性偏头痛、感音神经性听力障碍以及肉芽肿性多血管炎。因此，某些疾病的跨解剖表现导致了已被记录的诊断不足、诊断延迟和巨大的医疗保健成本。本评论提出向组织生理学分类系统的范式转变，该系统按组织类型、细胞机制和病理生理功能障碍来组织，而非仅按解剖分区。这样的框架将把目前标记为“非特异性症状”的表现重新定义为组织特异性表现。这可能改善对跨解剖疾病模式的认识，使耳鼻咽喉头颈外科与已在肿瘤学、胃肠病学和肺病学中带来变革的精准医学趋势保持一致。这一补充性分类层并不取代解剖学，而是增强诊断推理。需要前瞻性多中心研究比较两种框架之间的诊断准确性和结局，以验证这一方法。

英文摘要

Disease classification in otolaryngology remains rooted in anatomical frameworks from the 18th and 19th centuries, predating modern histopathology and pathophysiology. This anatomically driven approach may inadequately capture disorders that transcend anatomical boundaries, such as laryngopharyngeal reflux disease, vestibular migraine, neurosensory hearing, disorders, and granulomatosis with polyangiitis. The transanatomical presentations of some disorders contribute therefore to documented underdiagnosis, diagnostic delays, and substantial healthcare costs. This commentary proposes a paradigm shift toward a histophysiological classification system organized by tissue type, cellular mechanisms, and pathophysiological dysfunction rather than anatomical compartments alone. Such a framework would reframe currently labeled "non-specific symptoms" as tissue-specific presentations. That may improve recognition of transanatomical disease patterns, aligning otolaryngology with precision medicine trends already transforming oncology, gastroenterology, and pulmonology. This complementary classification layer does not replace anatomy but enhances diagnostic reasoning. Prospective multicenter studies comparing diagnostic accuracy and outcomes between frameworks are needed to validate this approach.