[Self-induced illness in ENT medical practice. Artefacts as a contribution to differential diagnosis of unusual illness courses].

Until now reports of factitious disease have not been found in the ENT literature. In contrast, the dermatologic literature estimates an incidence from 0.01 to 0.26%. In order to achieve effective treatment for these patients, knowledge of the characteristic symptoms is fundamental. The present paper describes the variety of disease possible, using three cases treated between 1992 and 1994 in the ENT Department of Cologne. According to the literature, females are involved in a ratio of 9:1, with the majority working in medically related professions. Depression and anorexia are typical symptoms. When a factitious disease is suspected, psychiatric consultation is essential. Confrontation of a suspect patient by the otolaryngologist is not often considered because several reports quote suicidal behavior in up to 25% of self-manipulating patients and tendencies to refuse to follow psychiatric treatment are considerable.