Psychophysiological Mechanisms Linking Psychological Stress to Functional Otolaryngological Symptoms: A Systematic Review and Meta-Analysis

Background: Functional otolaryngological (ENT) symptoms tinnitus, globus pharyngeus, and functional dysphonia frequently present without identifiable structural pathology. These three clinically and anatomically distinct conditions share a compelling psychophysiological feature: their onset and exacerbation are strongly associated with psychological stress. Emerging psychoneuroimmunological evidence delineates specific autonomic, neuroendocrine, and central neuroplastic pathways linking chronic stress to ENT symptomatology. Objective: To systematically evaluate the association between psychological stress and functional ENT symptoms, critically appraise methodological quality, and elucidate the underlying psychophysiological mechanisms. Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. PubMed and Scopus were searched using pre-specified Boolean strategies (2000–2025). Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Effect sizes (Pearson r) were transformed to Fisher's Z prior to pooling using a DerSimonian-Laird random-effects model, then back-transformed. Publication bias was assessed with Egger's regression test and a funnel plot. Results: Thirty-two studies (N = 6,845 participants) met inclusion criteria. The corrected pooled correlation was r = 0.46 (95% CI: 0.40–0.52; pooled Z = 0.499; p < 0.001; I² = 63%). Prediction interval: r = 0.19–0.65. Subgroup estimates: tinnitus r = 0.49 (0.43–0.55), globus pharyngeus r = 0.48 (0.40–0.56), functional dysphonia r = 0.41 (0.34–0.48). No significant publication bias (Egger's p = 0.17). Mean NOS quality score: 6.4/9. Conclusion: Psychological stress is significantly associated with functional ENT symptomatology via five interconnected mechanisms: autonomic dysregu