Functional ear symptoms referred to an otology clinic: incidence, co-morbidity, aetiological factors and a new experience-driven clinical model

Abstract

Objective This study aimed to review the incidence and co-morbidity of functional ear symptoms in new referrals to an adult otology clinic and present a clinical model based on neuroscientific concepts. Method This was a retrospective review of 1000 consecutive new referrals to an adult otology clinic. Results Functional disorder was the primary diagnosis in 346 patients (34.6 per cent). Functional ear symptoms included tinnitus (69.7 per cent), imbalance (23.7 per cent), otalgia (22.8 per cent) and aural fullness (19.1 per cent), with more than one symptom occurring in 25.1 per cent of patients. Co-morbidities included sensorineural hearing loss (39 per cent), emotional stress (30 per cent) and chronic illness (22 per cent). Conclusion Functional disorders commonly present to the otology clinic, often in the presence of emotional stress or chronic illness. They occur because of adaptation of brain circuitry to experience, including adverse events, chronic illness and fear learning. This study presented an experience-driven clinical model based on these concepts. An understanding of these principles will significantly aid otolaryngologists who encounter patients with functional ear symptoms.

Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective

“…And similarly, the vestibular system may be involved. Indeed, in 1000 patients presenting at an otology clinic, tinnitus was present in 70%, imbalance in about 25%, otalgia and aural fullness in about 20%, with more than one symptom occurring in 25% of patients [ 32 , 33 ]. The comorbidity of tinnitus and vestibular systems is most outspoken in Meniere’s disease, in which tinnitus and vertigo are part of the diagnostic criteria [ 34 , 35 ].…”

Functional ear symptoms, benign positional vertigo, arytenoid (vocal process) granuloma and early registrar training

“…Assessment can be far from straightforward. This issue's paper of the month, 1 by a team from Whipps Cross (London) and Anglia Ruskin (Cambridge), considers the matter in some detail, proposing a helpful model to assist the clinician in assessing this tricky group of patients. Reassuring a patient with the message that ‘the tests are normal with no need to worry’ is inadequate on its own, and this paper can help us offer the patient more.…”