Odor Provocation Test for Laryngeal Hypersensitivity

Jackie Gartner-Schmidt, Clark A. Rosen, Berrylin Ferguson

This case study was designed to present an odor provocation / challenge test for laryngeal hypersensitivity in a suspected odor induced dysphonic patient for a workman’s compensation suit. A modified single-subject A-B study design was implemented to attempt to relate the patient’s voice complaints with various odors. Five odors were presented with two odors representing negative controls (i.e., water). Three replications (e.g., sessions A, B, C) of the five odor presentations (counterbalanced) were presented. The patient was blindfolded and asked to nasally inhale the odors. The measurement variables were laryngopharyngeal constriction as viewed via flexible endoscopy and verbal confirmation. In between each odor presentation, the patient was asked to inhale benign stimuli and perform laryngeal postures to bring the larynx back to a “neutral setting”. Because the perception of odor may have been a confounding variable to the evaluation, a method for studying the perception of laryngeal hypersensitivity with limited influence of olfaction was utilized. Results are discussed as compared to one healthy control. Although the patient reacted to all nasally inhaled odors with much more laryngopharyngeal hypersensitivity than orally inhaled odors, a true cause and effect result may never be obtained due to the possibility of secondary gain. The healthy control did not react to any of the odors. This case presentation offers a structured and controlled evaluation for laryngeal hypersensitivity when secondary gain is suspected.

Jackie Gartner-Schmidt, Ph.D
University of Pittsburgh Department of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
412-647-2112 Fax 412-647-2080
gartnerschmidtjl@upmc.edu
Clark A. Rosen, M.D., FACS
rosenca@upmc.edu
Berrylin Ferguson, M.D., FACS
fergusonbj@upmc.edu
University of Pittsburgh
Department of Otolaryngology
200 Lothrop Street, Suite 500
Pittsburgh, PA 15213
412-647-2112 Fax 412-647-2080