Functional Illness of the Head and Neck

Review by L Flood
Middlesbrough, UK

There is that occasional title that inspires the thought “Genius, why did I not think of that?”, although tempered by the conviction that one might just be lacking a profound knowledge of the topic. For once we have a text that does not tackle the usual “What I can do with an endoscope” or “My philosophy on surgery of ear disease”. Instead, this addresses what comprises a major proportion of any clinician’s (and certainly the otolaryngologist’s) workload, all those medically unexplained maladies.

A nice opening chapter reminds us that many an illness was “unexplained” a century ago, but science progresses. It stresses the need for “a proper evaluation” before labelling anything as a functional illness. It is thought provoking in teaching us to distinguish linear from non-linear thinking and that the label of “functional” does not necessarily mean either psychogenic or imaginary. Statistics on the incidence and prevalence of functional illness are daunting and only illustrate the importance of this book. It highlights the need for an holistic approach, a place for placebo therapy and honest communication. The lack of a traditional high level of evidence base for treatment recommendations is particularly well explained and excused. I did like the comment about the sincere attempts of so medical committees in taxonomy; “Placing a name on something often makes us feel like we understand it and are in control”, while merely creating a false sense of security of course.

The next early chapters deal with the appropriate “basic sciences”, the science of the inflammatory process and allergy, the physiology of pain and chronic stress, depression and anxiety. These are sensibly brief chapters, understandable to even the simplest retired otologist.

The bulk of the book then comprises the many functional illnesses that, let us be honest, can sometimes be the despair of the busy clinician, if only because of that sense of helplessness.  The suggestion throughout is that medications that affect serotoninergic signalling may yet transform our management. Conditions range from chronic neck pain to tinnitus, sleep disorders, the burning mouth, dysphonia and dizziness. The last is only 8 pages of text, but quite fascinating and packed with pearls of wisdom. Every chapter carries a vast list of well updated references.

Finally come the chapters on therapy, whether pharmacologic, psychogenic or complementary / dietary. Functional illness in the paediatric clinic proved a surprise, as a concept easily overlooked.

In such a multi-author text some repetition is inevitable, but, frankly, many points did merit that emphasis. I would have liked a whole chapter on the psychological effect on the clinician who is repeatedly confronting functional illness, which is, admittedly, introduced in that first chapter. Ultimately the trainees will still invest in atlases showing what can be achieved with a high speed drill, a laser, a robot or an endoscope but this truly novel book would prove a far more useful exercise. The topic will make up a significant proportion (possibly a majority?) of a career and the most senior of us would benefit from reading this. Springer continue to contribute massively to the  ENT library but, at a glance, I felt sure this would be an invaluable addition and it proves so.

Amazon Link: Functional Illness of the Head and Neck
By purchasing books via this link you will help to fund the JLO