I had an increase in the number of patients presenting with globus sensation or other vague throat discomfort. Especially in those with limited objective findings, pandemic-related anxiety likely played a part in the etiology. —Scott Mann, MD
Explore This Issue
June 2021
During the five to 10 minutes Dr. Luong spent talking to her patient, she reassured the woman that she wasn’t alone in having these feelings—they were totally normal and appropriate during a pandemic. She encouraged the patient to seek counseling, if needed. The patient said she was upset but didn’t think she needed counseling at that time. They scheduled a recheck for a month later.
Dr. Cabrera-Muffly too has found it helpful to acknowledge to patients who look good but feel bad that it’s a very stressful time, and this is likely making their symptoms worse. “I’ve found that patients seem more willing to acknowledge stress as a factor affecting their health over the past year than they’ve been before,” she said. “That’s one of the rare positive outcomes of the COVID-19 pandemic—I feel that we’re easier on ourselves than we have been.”
Health Anxiety and Chronic Conditions
Chronic conditions can be accompanied by mental health concerns. A systematic literature review recently published in PLoS One found that as many as 20% of people with chronic illnesses have health anxiety about their condition progressing or recurring (PLoS One. 2020;15:e0234124). Add a pandemic to the mix and that number likely increases.
Most otolaryngology practices do not have a formal anxiety/depression screening on intake for their patients. Dr. Luong thinks, however, that it may be a good idea to have nurses ask patients a few questions about increased stress or changes in eating, sleep, or mood to screen for anxiety or depression before the doctor comes in, particularly for patients with chronic rhinosinusitis (CRS). According to a 2019 study Dr. Luong co-authored with colleagues in the department of otorhinolaryngology at McGovern Medical School at UTHealth, depression may be underdiagnosed in patients with CRS. The paper, presented at the American Rhinologic Society, assessed the prevalence of depression in a rhinology practice by comparing results of the Patient Health Questionnaire-9 (PHQ-9), a depression screening tool, to the 22-item Sinonasal Outcome Test (SNOT-22) used to screen for sinonasal symptoms. The study found that depression rates, as estimated by PHQ-9 responses, were similar to those in all chronic disease populations, and that higher SNOT-22 scores are associated with higher PHQ-9 scores. “From working on that paper, I’m more inclined to consider a patient’s mental health when treating their chronic disease,” Dr. Luong said.
Scott Mann, MD, assistant professor of otolaryngology at the CU School of Medicine in Aurora, said that 2020 brought significant changes in the conditions he and his colleagues have been seeing, some of which may have had a mental health component. “I had an increase in the number of patients presenting with globus sensation or other vague throat discomfort,” he said. “Especially in those with limited objective findings, pandemic-related anxiety likely played a part in the etiology. We also noticed an increase in symptoms that can be exacerbated by anxiety, such as tinnitus, temporomandibular dysfunction pain, migraine variants, and muscle-tension dysphonia.”
Another mental health issue that may come up for sinus and chronic cough patients is the anxiety brought on by the fear that these might be symptoms of COVID-19.
“In many cases, particularly with cough, patients find that they are isolating themselves further due to their perception of how other people perceive their runny nose, sneezing, or coughing. This can be incredibly stressful to patients,” said Michael Benninger, MD, chairman of Cleveland Clinic’s Head & Neck Institute and a professor of surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Ohio.