Medically Unexplained Otorhinolaryngological Symptoms: Towards Integrated Psychiatric Care

Objective: To evaluate the presence of medically unexplained otorhinolaryngological symptoms in a patient cohort and propose an interdisciplinary approach for their care. Study Design: Prospective cohort study. Methods: The study describes the population of patients presenting consecutively at the Department of Otorhinolaryngology at the Maastricht University Medical Center. Patients with symptoms who did not meet clear "medical" criteria and were associated with psychological distress and high health care utilization were enrolled in the study by two experienced otorhinolaryngologists following informed consent. The aim of the study is 1) to specify the presence of medically unexplained otorhinolaryngological symptoms and 2) to evaluate the integration of otorhinolaryngological and psychiatric treatment in an interdisciplinary approach in order to help otorhinolaryngologists improve patient care. Results: Of the 102 patients included, 41% (N=42) did not have a proven somatic otorhinolaryngological diagnosis. For only 10.8% (N=4) of the latter, no psychiatric diagnosis had been established. Overall, 78% of the study population (N=80) was diagnosed with psychiatric morbidity/comorbidity, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Conclusion: The preliminary data suggest that the majority of patients with these unexplained complaints may suffer from under-or undiagnosed psychiatric morbidity. Therefore, easy access to integrated interdisciplinary care (otorhinolaryngology and psychiatry) should be offered to patients with medically unexplained otorhinolaryngological symptoms after detailed information is made available to them about the pathogenesis of the complaints and the foreseen psychosomatic approach.