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Medically unexplained symptoms and somatisation in ENT

Published online by Cambridge University Press:  10 April 2013

G Ullas ,
L McClelland  and
N S Jones
G Ullas
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, UK
L McClelland
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, UK
N S Jones*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, UK
*
Address for correspondence: Prof N S Jones, Department of Otorhinolaryngology, Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK E-mail: [email protected]
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Abstract

Background:

Somatisation has been described as the perception of a physiological event influenced by emotion.

Method:

A review of the medical literature was carried out using the following Medical Subject Headings: somatisation (which identified 357 articles), medically unexplained symptoms (749 articles), unexplained or idiopathic dizziness (142 articles), tinnitus (360 articles), catarrh (1068 articles) and globus pharyngeus (3114 articles).

Results:

Up to 40 per cent of out-patient attendances have medically unexplainable symptoms. In ENT clinics, this includes patients with dizziness, tinnitus, ‘pseudo’ eustachian tube dysfunction, being ‘unable to hear’, catarrh and postnasal drip, atypical facial pain, globus pharyngeus, and functional dysphonia. Medical explanations of these symptoms often differ from patients' perceptions. Demonstrating normal test results and providing reassurance have little effect on patients' doubts and anxieties. Consultations that recognise the symptoms and their impact, and offer a tangible and involving explanation are more likely to satisfy and empower patients.

Conclusion:

The treatment of medically unexplained symptoms has changed in recent years; there is now more emphasis on psychological factors due to an association with anxiety and depression.

Keywords

SomatizationMedically Unexplained SymptomsOtorhinolaryngologyDizzinessTinnitusCatarrhGlobus Pharyngeus
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 5 , May 2013 , pp. 452 - 457
Copyright
Copyright © JLO (1984) Limited 2013 

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References

1Steckel, W. The Interpretation of Dreams. New York: Liveright, 1943Google Scholar
2Sharpe, M, Carson, A. “Unexplained” somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med 2001;134:926–30CrossRefGoogle ScholarPubMed
3Reidenberg, M, Lowenthal, D. Adverse non-drug reactions. N Engl J Med 1968;279:678–87CrossRefGoogle Scholar
4Pennebaker, JW, Burnam, MA, Schaeffer, MA, Harper, DC. Lack of control as a determinant of perceived physical symptoms. J Pers Soc Psychol 1977;35:167–74CrossRefGoogle ScholarPubMed
5Kirmayer, LJ, Robbins, JM. Three forms of somatization in primary care: prevalence, co-occurrence and sociodemographic characteristics. J Nerv Ment Dis 1991;179:647–55CrossRefGoogle ScholarPubMed
6Fink, P, Sorensen, L, Engberg, M, Holm, M, Munk-Jorgensen, P. Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics 1999;40:330–8CrossRefGoogle ScholarPubMed
7Bridges, KW, Goldberg, DP. Somatic presentation of DSM-III psychiatric disorders in primary care. J Psychosom Res 1985;29:563–9CrossRefGoogle ScholarPubMed
8Goto, F, Tsutsumi, T, Oishi, N, Mimura, M. Hidden depression in otolaryngology patients with medically unexplained symptoms. Gen Hosp Psychiatry 2012;34:206–8CrossRefGoogle ScholarPubMed
9Kellner, R. Somatization. Theories and research. J Nerv Ment Dis 1990;178:150–60CrossRefGoogle ScholarPubMed
10Pennebaker, JW. Perceptual processes II: schemas, selective search, and inference. In: The Psychology of Physical Symptoms. New York: Springer-Verlag, 1982;37–49CrossRefGoogle Scholar
11Lipowski, ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988;145:1358–68Google ScholarPubMed
12Salmon, P, Peters, S, Stanley, I. Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ 1999;318:372–6CrossRefGoogle ScholarPubMed
13Honaker, JA, Gilbert, JM, Staab, JP. Chronic subjective dizziness versus conversion disorder: discussion of clinical findings and rehabilitation. Am J Audiol 2010;19:3–8CrossRefGoogle ScholarPubMed
14Clark, MR, Sullivan, MD, Katon, WJ, Russo, JE, Fischl, M, Dobie, RA et al. Psychiatric and medical factors associated with disability in patients with dizziness. Psychosomatics 1993;34:409–15CrossRefGoogle ScholarPubMed
15Staab, JP, Ruckenstein, MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg 2007;133:170–6CrossRefGoogle ScholarPubMed
16Staab, JP. Chronic dizziness: the interface between psychiatry and neuro-otology. Curr Opin Neurol 2006;19:41–8CrossRefGoogle ScholarPubMed
17Ödman, M, Maire, R. Chronic subjective dizziness. Acta Otolaryngol 2008;128:1085–8CrossRefGoogle ScholarPubMed
18Ruckenstein, MJ, Staab, JP. Chronic subjective dizziness. Otolaryngol Clin North Am 2009;42:71–7CrossRefGoogle ScholarPubMed
19Staab, JP, Ruckenstein, MJ. Chronic dizziness and anxiety: effect of course of illness on treatment outcome. Arch Otolaryngol Head Neck Surg 2005;131:675–9CrossRefGoogle ScholarPubMed
20Edelman, S, Mahoney, AE, Cremer, PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol 2012;33:395–401CrossRefGoogle ScholarPubMed
21Roberts, LE, Eggermont, JJ, Caspary, DM, Shore, SE, Melcher, JR, Kaltenbach, JA. Ringing ears: the neuroscience of tinnitus. J Neurosci 2010;30:14972–9CrossRefGoogle ScholarPubMed
22Langguth, B, Landgrebe, M, Kleinjung, T, Sand, GP, Hajak, G. Tinnitus and depression. World J Biol Psychiatry 2011;12:489–500CrossRefGoogle ScholarPubMed
23Langguth, B. A review of tinnitus symptoms beyond 'ringing in the ears': a call to action. Curr Med Res Opin 2011;27:1635–43CrossRefGoogle ScholarPubMed
24Belli, H, Belli, S, Oktay, MF, Ural, C. Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment. Gen Hosp Psychiatry 2012;34:282–9CrossRefGoogle ScholarPubMed
25Hesser, H, Weise, C, Westin, VZ, Andersson, G. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clin Psychol Rev 2011;31:545–53CrossRefGoogle ScholarPubMed
26Shapiro, J. Ask the doctor. I have a feeling of fullness in my ears that won't go away. I think it has been diagnosed as something called eustachian tube dysfunction. I have been to several otolaryngologists. Nothing has worked. Suggestions? Harv Health Lett 2011;36:8Google Scholar
27McCoul, ED, Anand, VK, Christos, PJ. Validating the clinical assessment of eustachian tube dysfunction: The Eustachian Tube Dysfunction Questionnaire (ETDQ-7). Laryngoscope 2012;122:1137–41CrossRefGoogle ScholarPubMed
28Homer, J, Jones, NS, Sheard, C, Herbert, M. Cognitive dissonance, the placebo effect and the evaluation of surgical results. Clin Otolaryngol 2000;25:195–9CrossRefGoogle ScholarPubMed
29Saunders, GH, Haggard, MP. The clinical assessment of obscure auditory dysfunction–1. Auditory and psychological factors. Ear Hear 1989;10:200–8CrossRefGoogle ScholarPubMed
30Moore, BCJ. Psychoacoustics. In: Rossing, TD, ed. Springer Handbook of Acoustics. New York: Springer, 2007;459–69CrossRefGoogle Scholar
31Shaw, GM, Jardine, CA, Fridjhon, P. A pilot investigation of high-frequency audiometry in obscure auditory dysfunction (OAD) patients. Br J Audiol 1996;30:233–7CrossRefGoogle ScholarPubMed
32Clifton, N, Jones, NS. The prevalence of facial pain in 108 consecutive patients with paranasal mucopurulent discharge at endoscopy. J Laryngol Otol 2007;121:345–8CrossRefGoogle ScholarPubMed
33Cathcart, RA, Wilson, JA, May, C. The conversion from sensation to symptom: the case of catarrh, a qualitative study. Chronic Illn 2012;8:3–16CrossRefGoogle ScholarPubMed
34Cathcart, RA, Wilson, JA. Should chronic catarrh patients seen in primary care be referred for further investigations? Int J Clin Pract 2011;65:985–8CrossRefGoogle ScholarPubMed
35Morice, AH. Post-nasal drip syndrome–a symptom to be sniffed at? Pulm Pharmacol Ther 2004;17:343–5CrossRefGoogle Scholar
36Quraishi, S, Jones, NS, Mason, J. The rheology of nasal mucus. Clin Otolaryngol 1998;23:403–13CrossRefGoogle ScholarPubMed
37Acharya, AN, Mirza, S, Jones, NS. Ice cold carbonated water: a therapy for persistent hyperawareness of pharyngeal mucus and throat clearing. J Laryngol Otol 2007;121:354–7CrossRefGoogle ScholarPubMed
38Güler, N, Durmus, E, Tuncer, S. Long-term follow-up of patients with atypical facial pain treated with amitriptyline. N Y State Dent J 2005;71:38–42Google ScholarPubMed
39Ishida, S, Kimura, H. Therapy for atypical facial pain [in Japanese]. Nihon Rinsho 2009;67:1803–9Google ScholarPubMed
40Gale, CR, Wilson, JA, Deary, IJ. Globus sensation and psychopathology in men: the Vietnam experience study. Psychosom Med 2009;71:1026–31CrossRefGoogle ScholarPubMed
41Kiese-Himmel, C. Globus sensation: a clinical review [in German]. HNO 2010;58:586–94CrossRefGoogle ScholarPubMed
42Altman, KW, Atkinson, C, Lazarus, C. Current and emerging concepts in muscle tension dysphonia: a 30-month review. J Voice 2005;19:261–7CrossRefGoogle ScholarPubMed
43Van Houtte, E, Van Lierde, K, Claeys, S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice 2011;25:202–7CrossRefGoogle ScholarPubMed
44Bos-Clark, M, Carding, P. Effectiveness of voice therapy in functional dysphonia: where are we now? Curr Opin Otolaryngol Head Neck Surg 2011;19:160–4CrossRefGoogle ScholarPubMed
45Deary, V, Miller, T. Reconsidering the role of psychosocial factors in functional dysphonia. Curr Opin Otolaryngol Head Neck Surg 2011;19:150–4CrossRefGoogle ScholarPubMed
46O'Hara, J, Miller, T, Carding, P, Wilson, J, Deary, V. Relationship between fatigue, perfectionism, and functional dysphonia. Otolaryngol Head Neck Surg 2001;114:921–6Google Scholar
47Ruotsalainen, JH, Sellman, J, Lehto, L, Jauhiainen, M, Verbeek, JH. Interventions for treating functional dysphonia in adults. Cochrane Database Syst Rev 2007;(18):CD006373CrossRefGoogle ScholarPubMed
48Ruotsalainen, J, Sellman, J, Lehto, L, Verbeek, J. Systematic review of the treatment of functional dysphonia and prevention of voice disorders. Otolaryngol Head Neck Surg 2008;138:557–65Google ScholarPubMed
49Daniilidou, P, Carding, P, Wilson, J, Drinnan, M, Deary, V. Cognitive behavioral therapy for functional dysphonia: a pilot study. Ann Otol Rhinol Laryngol 2007;116:717–22CrossRefGoogle ScholarPubMed
50Schumacher, S, Reif, W, Brahler, E, Martin, A, Glaesmer, H, Mewes, R. Disagreement in doctor's and patient's rating about medically unexplained symptoms and health care use. Int J Behav Med 2011. Epub 2011 Dec 21Google Scholar
51Dowrick, CF, Ring, A, Humphris, GM, Salmon, P. Normalisation of unexplained symptoms by general practitioners: a functional typology. Br J Gen Pract 2004;54:165–70Google ScholarPubMed
52Hansen, HS, Rosendal, M, Oernboel, E, Fink, P. Are medically unexplained symptoms and functional disorders predictive for the illness course? A two-year follow-up on patients' health and health care utilisation. J Psychosom Res 2011;71:38–44CrossRefGoogle ScholarPubMed
53Balint, M. The Doctor, His Patient and the Illness. Edinburgh: Churchill Livingstone, 2000Google Scholar
54van der Feltz-Cornelis, CM, Hoedeman, R, Keuter, EJ, Swinkles, JA. Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. J Psychosom Res 2012;72:168–9CrossRefGoogle ScholarPubMed