Association Between Patient Review of Systems Score and Somatization

Okland, Tyler S.; Gonzalez, Joseph R.; Ferber, Alexander T.; Mann, Scott E.

doi:10.1001/jamaoto.2017.0671

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…The prevalence of PET in our cohort is likely greater given that 44% of patients reported autophony symptoms. However patients in other settings sometimes report aural symptoms when there are no objective findings of disease‐ and the rate of this reporting is higher in those with psychiatric diagnoses 19 . We sought to identify clinically significant autophony with the addition of a validated tool to assess for eustachian tube dysfunction (ETDQ‐7) 15 .…”

Section: Discussionmentioning

confidence: 99%

“…However patients in other settings sometimes report aural symptoms when there are no objective findings of disease‐ and the rate of this reporting is higher in those with psychiatric diagnoses. 19 We sought to identify clinically significant autophony with the addition of a validated tool to assess for eustachian tube dysfunction (ETDQ‐7). 15 Although the ETDQ‐7 identifies individuals with either dilatory or patulous ET dysfunction, it is limited by being unable to discriminate between the two types.…”

Section: Discussionmentioning

confidence: 99%

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Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Mann

Hollis

Frederics

et al. 2022

Laryngoscope Investig Oto

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Objectives To understand the presence of transient autophony symptoms in patients being treated for severe anorexia nervosa (AN), and whether those symptoms were due to patulous eustachian tube (PET). Methods A prospective observational study was performed in patients requiring admission for treatment of severe AN. All enrolled patients completed The Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) and were screened for symptoms of autophony. If patients reported autophony and had a score of ≥14.5 on the ETDQ‐7 they were asked to undergo comprehensive audiological testing and an evaluation with an otolaryngologist. Results Of the 73 patients enrolled in the study, 35 patients (44%) reported autophony and 36 (49%) scored 14.5 or higher on the ETDQ‐7. Of the 16 (22%) patients who had both autophony and an ETDQ‐7 score of 14.5 or higher, 7 patient s (representing 11 symptomatic ears) underwent evaluations by audiology and otolaryngology. Every evaluation of a symptomatic ear revealed objective evidence of PET. Nine of 11 (81.8%) symptomatic ears had subjectively resolved within 12 days of admission after nutritional rehabilitation and weight gain. Conclusion Transient autophony in severe AN patients is due to PET, and was present in at least 8% of patients within our cohort. Further study is warranted to understand the quality of life impact and pathophysiology of transient PET in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Mann

Hollis

Frederics

et al. 2022

Laryngoscope Investig Oto

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“…It is also notable that MAs are reported more frequently in patients with depression ( 48 , 49 ), anxiety ( 49 ), dissociative symptoms ( 50 ), and increased life stressors ( 51 ). Given that symptom overreporting has been demonstrated to be more frequent among patients with psychiatric diagnoses ( 52 , 53 ), it is possible that patients with MAs are more likely to report symptoms at time of follow-up, accounting for the increase in late toxicity observed. However, these alternative biologic mechanisms and/or symptom overreporting would not explain the improvement in biochemical control seen in patients with MAs and therefore seem unlikely to be the sole cause of the differences in the long-term outcomes reported herein.…”

Section: Discussionmentioning

confidence: 99%

Prostate Cancer Radiotherapy: Increased Biochemical Control and Late Toxicity in Men With Medication Allergies

Turchan

Gutiontov

Spiotto

et al. 2020

JNCI Cancer Spectrum

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Background Given similarities in the mediators of medication allergy (MA) and tissue response to radiotherapy, we assessed whether outcomes following prostate radiotherapy differ in patients with MAs. Methods 587 men with known MA history and non-metastatic prostate cancer underwent radiotherapy from 1989-2006. Clinicopathologic and treatment variables were analyzed for association with freedom from biochemical failure (FFBF) and late treatment-related, physician-defined Radiation Therapy Oncology Group gastrointestinal (GI) and genitourinary (GU) toxicity. Covariates identified on univariate analysis (UVA) for toxicity and disease control were examined on multivariable analysis (MVA). All statistical tests were two-sided and a P < .05 was considered statistically significant. Results 155 of 587 men (26.4%) had one or more MAs, most commonly to penicillin (n = 71), sulfa (n = 35) and aspirin/NSAIDs (n = 28). On UVA, men with MA had superior 10-y FFBF (71.5% vs. 63.5%, P = .02) and higher incidence of late GI grade 2 + (G2+; 20.6% vs. 13.2%, P = .04) and grade 3 + (G3+; 7.5% vs. 3.9%, P = .08), as well as late GU G2 + (42.5% vs. 33.2%, P = .04) and G3 + (7.5% vs. 3.0%, P = .02) toxicity than men without MA. On MVA, MA history remained a statistically significant predictor of FFBF (HR = 0.64 [95% CI = 0.43 to 0.93]; P = .02), late G2+ GI (HR = 1.76 [95% CI = 1.06 to 2.90]; P = .03) and G3+ GU (HR = 2.69 [95% CI = 1.16 to 6.27]; P = .02) toxicity after controlling for corresponding covariates in each model. Conclusions Men with MA had improved FFBF and increased treatment-related toxicity following radiotherapy for prostate cancer. MA history could be a relevant consideration in the management of men with localized prostate cancer.

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“…The propensity to multiple unexplained physical symptoms can be quantified by completion of a Review Of Symptoms or similar checklist. 116 In a recent therapy trial, 148 refractory globus patients were randomised to receive 6 weeks of paroxetine, amitriptyline or lansoprazole. Response (> 50% reduction on the Glasgow Edinburgh Throat Scale) was achieved by 72% of paroxetine users, 46% of those on amitriptyline and only 14% of the lansoprazole group.…”

Section: Psychological Aspectsmentioning

confidence: 99%

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

Wilson

Stocken

Watson

et al. 2021

Health Technol Assess

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Background Persistent throat symptoms are commonly attributed to ‘laryngopharyngeal reflux’. Despite a limited evidence base, these symptoms are increasingly being treated in primary care with proton pump inhibitors. Objective To assess the value of proton pump inhibitor therapy in patients with persistent throat symptoms. Design This was a double-blind, placebo-controlled, randomised Phase III trial. Setting This was a multicentre UK trial in eight UK ear, nose and throat departments. Participants A total of 346 participants aged ≥ 18 years with persistent throat symptoms and a Reflux Symptom Index score of ≥ 10, exclusive of the dyspepsia item, were recruited. Intervention Random allocation (1 : 1 ratio) to either 30 mg of lansoprazole twice daily or matched placebo for 16 weeks. Main outcome measure Symptomatic response (i.e. total Reflux Symptom Index score after 16 weeks of therapy). Results A total of 1427 patients were screened and 346 were randomised. The mean age was 52 years (standard deviation 13.7 years, range 20–84 years); 150 (43%) participants were male and 196 (57%) were female; 184 (53%) participants had a mild Reflux Symptom Index minus the heartburn/dyspepsia item and 162 (47%) had a severe Reflux Symptom Index minus the heartburn/dyspepsia item. A total of 172 patients were randomised to lansoprazole and 174 were randomised to placebo. Main outcomes A total of 267 participants completed the primary end-point visit (lansoprazole, n = 127; placebo, n = 140), of whom 220 did so between 14 and 20 weeks post randomisation (‘compliant’ group); 102 received lansoprazole and 118 received placebo. The mean Reflux Symptom Index scores at baseline were similar [lansoprazole 22.0 (standard deviation 8.0), placebo 21.7 (standard deviation 7.1), overall 21.9 (standard deviation 7.5)]. The mean Reflux Symptom Index scores at 16 weeks reduced from baseline in both groups [overall 17.4 (standard deviation 9.9), lansoprazole 17.4 (standard deviation 9.9), placebo 15.6 (standard deviation 9.8)]. Lansoprazole participants had estimated Reflux Symptom Index scores at 16 weeks that were 1.9 points higher (worse) than those of placebo participants (95% confidence interval –0.3 to 4.2; p adj = 0.096), adjusted for site and baseline severity. Secondary outcomes Ninety-five (43%) participants achieved a Reflux Symptom Index score in the normal range (< 12) at 16 weeks: 42 (41%) in the lansoprazole group and 53 (45%) in the placebo group. A total of 226 participants completed the end-of-trial follow-up visit (lansoprazole, n = 109; placebo, n = 117), of whom 181 were ‘compliant’. The mean Reflux Symptom Index scores at 12 months reduced from baseline in both groups [lansoprazole 16.0 (standard deviation 10.8), placebo 13.6 (standard deviation 9.6), overall 14.7 (standard deviation 10.2)]. A total of 87 (48%) participants achieved a Reflux Symptom Index score in the normal range at 12 months: 33 (40%) in the lansoprazole group and 54 (55%) in the placebo group. Likewise, the Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life total scores and subscales all showed very similar changes in the lansoprazole and placebo cohorts at both 16 weeks and 12 months. Limitations Drop-out rate and compliance are issues in pragmatic clinical trials. The Trial Of Proton Pump Inhibitors in Throat Symptoms (TOPPITS) aimed to detect clinically relevant difference with 90% power. The 346 randomised participants reduced to 283 at the primary end point; 267 completed the primary outcome measure, 220 within the protocol time scale. Despite this, the powers to detect the clinically relevant difference in Reflux Symptom Index score at 16 weeks were 82% (compliant comparison) and 89% (pragmatic comparison). The lack of difference between lansoprazole and placebo is generalisable across NHS clinics. Conclusions Participants on lansoprazole did not report significantly better outcomes than participants on placebo on any of the three patient-reported outcome tools (Reflux Symptom Index, Comprehensive Reflux Symptom Score and Laryngopharyngeal Reflux – Health Related Quality of Life). This multicentre, pragmatic, powered, definitive Phase III trial found no evidence of benefit for patients by treating persistent throat symptoms with lansoprazole. Trial registration Current Controlled Trials ISRCTN38578686 and EudraCT number 2013-004249-17. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 3. See the NIHR Journals Library website for further project information.

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Association Between Patient Review of Systems Score and Somatization

Abstract: The manner in which patients respond to a standardized ROS differs in those with medically unexplained symptoms and in those with psychiatric disease. The ROS offers information beyond the actual systems review, and may be useful in the identification of somatization.

Cited by 10 publications

References 17 publications

Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Transient patulous eustachian tube in severe anorexia nervosa: A prospective observational study

Prostate Cancer Radiotherapy: Increased Biochemical Control and Late Toxicity in Men With Medication Allergies

Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT

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