When symptoms don’t fit: a case series of conversion disorder in the pediatric otolaryngology practice

Table 1 Approach to the atypical ENT patient

Establish broad differential diagnoses^a
Organic diseases
Non-organic diseases	Pseudohypacusis
	Functional upper airway obstruction
	Conversion disorder
	Adjustment disorder
	Autism spectrum disorders
Patient evaluation	Thorough history and physical examination including flexible nasolaryngoscopy
	Audiometry and vestibular testing should be performed to rule out organic pathology as indicated by the presenting complaint
	Consultation with relevant specialists including neurology and psychiatry
	Consider neuroimaging to rule out structural pathology
Treatment overview	Assessment of goals with staff, patient and family
	Confirm belief in presenting symptoms
	Avoid accusation
	Ensure patient and family is connected with appropriate community resources including physical or psychological rehabilitation
	Arrange follow-up visits

^a This should be a resource utilized by clinicians in appropriate cases where an organic pathology has been ruled out