7 When a MUS is determined to be a manifestation of underlying psychological distress, it is called somatization. 5, 6 Patients presenting with globus sensation (another symptom often associated with few objective findings) are more likely to have a diagnosis of major depression, generalized anxiety disorder, somatization disorder, posttraumatic stress disorder, and drug abuse. Patients reporting tinnitus or dizziness are more likely than others to experience anxiety or depression. There is, however, a clear connection between these types of symptoms and psychiatric disease. For instance, while a report of hearing loss will often be corroborated with findings on audiologic testing, objective abnormalities in those presenting with dizziness or tinnitus are less commonly found. Some of these symptoms remain unexplained after further testing and are challenging to relieve.

Otolaryngologists are frequently consulted for symptoms that have limited physical examination findings. Ear, nose, and throat symptoms were the third most common MUS among those surveyed. A community survey conducted by Kirmayer et al 3 reported that 10.5% of participants had an unexplained symptom in the prior year. 1, 2 This level of use represents a significant burden on the health care system, including otolaryngology. Patients with MUS are frequent utilizers of the health care system and account for up to one-third of all primary care evaluations and 21% of specialty consultations. Medically unexplained symptoms (MUS) are somatic symptoms for which a pathophysiologic mechanism cannot be identified. The ROS offers information beyond the actual systems review, and may be useful in the identification of somatization. Psychiatric comorbidity (median, 10 range, 0-41) was associated with higher ROSS than patients without psychiatric comorbidity (median, 5.5 range, 0 to 36) (median difference, 5 95% CI, 3 to 6).Ĭonclusions and Relevance The manner in which patients respond to a standardized ROS differs in those with medically unexplained symptoms and in those with psychiatric disease. Group A (hoarseness, nasal obstruction, and hearing loss: median ROSS, 6, range, 0-41) exhibited lower ROSS than group B (dizziness, globus sensation, and tinnitus: median ROSS, 9 range, 0-39) (median difference, −2 95% CI −3 to −1). Among patients with medically unexplained symptoms (median, 11 range, 0-39), the ROSS was higher compared with those with objective clinical findings (median, 6 range, 0-31) (median difference, 4 95% CI, 3 to 6). Results Of the 605 patients included in the analysis, 346 (57.2%) were women, and the mean (SD) age was 51.6 (15.7) years. Objective clinical findings, symptoms, and psychiatric comorbidities were recorded. Main Outcomes and Measures Number of affirmative responses on a standardized, 69-point ROS was recorded as a ROS score (ROSS). Current or past psychiatric comorbidities were also examined. Objective clinical findings after physical examination and related testing were reviewed and classified as either significant, marginal, or absent. Objectives To determine whether patients with somatization respond differently to the review of systems (ROS) portion of the patient interview and whether the ROS can be used to identify patients with somatization.ĭesign, Setting, and Participants A retrospective review of medical records of 2120 consecutive consultations of English- or Spanish-speaking patients aged 18 to 89 years who presented to the otolaryngology clinic from January 1, 2014, to November 10, 2015, was conducted to compare how the ROS of patients with chief complaints associated with somatization (group B: globus sensation, dizziness, and tinnitus) differs from those with symptoms more often associated with objective findings (group A: nasal obstruction, hoarseness, and hearing loss) a total of 605 patients were included. Recognition of somatization can be difficult, and there are limited methods available. Importance Somatization is a condition in which psychological distress is manifested by medically unexplained symptoms, and it is prevalent in all medical specialties, including otolaryngology. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.

Review of systems form