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 book 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 a holistic approach, a place for placebo therapy and honest communication. The lack of a traditional high-level evidence base for treatment recommendations is particularly well explained and excused. I did like the comment about the sincere attempts of so many 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 chapter is only eight pages of text, but is 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 pharmacological, psychogenic, or complementary or 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 reading 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 continues to contribute massively to the ENT library; at a glance, I felt sure this would be an invaluable addition and it proves so.
