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Table 1 Approach to the atypical ENT patient

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

Establish broad differential diagnosesa
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
  1. a This should be a resource utilized by clinicians in appropriate cases where an organic pathology has been ruled out