Top

European Archives of Oto-Rhino-Laryngology

Published in:

01-06-2019 | Laryngoscopy | Head & Neck

The gagging patient in ORL examinations: predictors, evaluation and treatment

Authors: David Zuschlag, Philipp Kulas, Bernhard Schick, Alessandro Bozzato

Published in: European Archives of Oto-Rhino-Laryngology | Issue 6/2019

Abstract

Purpose

Gagging may be a challenge in daily otorhinolaryngology (ORL) routine. This cross-sectional study aimed to examine conditions of gagging as limitation to ORL examination and the efficacy of acupressure as tool to reduce exaggerated gagging.

Methods

The study was conducted on a total of 360 study subjects. There was a survey part and a routine ORL examination with observation of gagging behaviour. Through binomial univariate logistic regression, predictors of clinically relevant exaggerated gagging were identified. Wilcoxon signed rank test was used to evaluate efficacy of acupressure point CV-24 to reduce gagging while examination.

Results

First gagging’s relevance was indicated by over 40% of study subjects showing clinically relevant exaggerated gagging. Furthermore, we found that more psychogenic than somatogenic features proved to be predictors of exaggerated gagging. Third acupressure point CV-24 showed statistical significant reduction of gagging intensity and improved examination feasibility.

Conclusion

Awareness of exaggerated gagging’s predictors are the first step to deal with gagging in daily practice. Acupressure might be an effective tool to overcome gagging in the affected patients.

Level of evidence

We suggest at least Level IV according to Oxford (UK) CEBM Levels of Evidence.

Available only for authorised users

Dickinson C (2000) Gagging problems in dental patients: literature review for the diploma in dental sedation. GKT Dental Institute of King’s College London

Dickinson CM, Fiske J (2005) A review of gagging problems in dentistry: I. Aetiology and classification. Dent Update 32(1):26–32CrossRefPubMed

Hearing CM, Bind RH, Tabacco MJ, Hallock RM (2014) A reliable and valid survey to predict a patient’s gagging intensity. J Oral Maxillofac Res 5(2):e3. https://doi.org/10.5037/jomr.20014.5203 CrossRefPubMedPubMedCentral

Linden Van, van den Heuvell GF, Ter Pelkwijk BJ, Stegenga B (2008) Development of the gagging problem assessment: a pilot study. J Oral Rehabil 35(3):196–202. https://doi.org/10.1111/j.1365-2842.2007.01774.x CrossRef

Bassi GS, Humphris GM, Longman LP (2004) The etiology and management of gagging: a review of the literature. J Prosthet Dent 91(5):459–467. https://doi.org/10.1016/S0022391304000939 CrossRefPubMed

Hoad-Reddick G (1986) Gagging: a chairside approach to control. Br Dent J 161(5):174–176. https://doi.org/10.1038/sj.bdj.4805922 CrossRefPubMed

Conny DJ, Tedesco LA (1983) The gagging problem in prosthodontic treatment. Part II: patient management. J Prosthet Dent 49(6):757–761CrossRefPubMed

Krol AJ (1963) A new approach to the gagging problem. J Prosthet Dent 13(4):611–616. https://doi.org/10.1016/0022-3913(63)90131-8 CrossRef

Kramer RB, Braham RL (1977) The management of the chronic or hysterical gagger. ASDC J Dent Child 44(2):111–116PubMed

10.

Rosted P, Bundgaard M, Fiske J, Pedersen AM (2006) The use of acupuncture in controlling the gag reflex in patients requiring an upper alginate impression: an audit. Br Dent J 201(11):721–725. https://doi.org/10.1038/sj.bdj.4814305 (discussion 715) CrossRefPubMed

11.

Rosler A, Otto B, Schreiber-Dietrich D, Steinmetz H, Kessler KR (2003) Single-needle acupuncture alleviates gag reflex during transesophageal echocardiography: a blinded, randomized, controlled pilot trial. J Altern Complement Med 9(6):847–849. https://doi.org/10.1089/107555303771952190 CrossRefPubMed

12.

Samsoon GL, Young JR (1987) Difficult tracheal intubation: a retrospective study. Anaesthesia 42(5):487–490CrossRefPubMed

13.

Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL (1985) A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 32(4):429–434CrossRefPubMed

14.

Dickinson CM, Fiske J (2005) A review of gagging problems in dentistry: 2. Clinical assessment and management. Dent Update 32(2):74–80CrossRefPubMed

15.

Wright SM (1981) Medical history, social habits, and individual experiences of patients who gag with dentures. J Prosthet Dent 45(5):474–478CrossRefPubMed

16.

Holm S (1979) A simple sequentially rejective multiple test procedure. Scand J Stat 6(2):65–70

17.

van Houtem CM, van Wijk AJ, Boomsma DI, Ligthart L, Visscher CM, de Jongh A (2015) Self-reported gagging in dentistry: prevalence, psycho-social correlates and oral health. J Oral Rehabil 42(7):487–494. https://doi.org/10.1111/joor.12289 CrossRefPubMed

18.

Randall CL, Shulman GP, Crout RJ, McNeil DW (2014) Gagging and its associations with dental care-related fear, fear of pain and beliefs about treatment. J Am Dent Assoc 145(5):452–458. https://doi.org/10.14219/jada.2013.50 CrossRefPubMedPubMedCentral

19.

Hornby PJ (2001) Central neurocircuitry associated with emesis. Am J Med 111(Suppl 8A):106S–112SCrossRefPubMed

20.

Hainsworth JM, Hill KB, Rice A, Fairbrother KJ (2008) Psychosocial characteristics of adults who experience difficulties with retching. J Dent 36(7):494–499. https://doi.org/10.1016/j.jdent.2008.03.011 CrossRefPubMed

21.

Vachiramon A, Wang WC (2002) Acupressure technique to control gag reflex during maxillary impression procedures. J Prosthet Dent 88(2):236CrossRefPubMed

22.

White A, Editorial Board of Acupuncture in M (2009) Western medical acupuncture: a definition. Acupunct Med 27(1):33–35. https://doi.org/10.1136/aim.2008.000372 CrossRefPubMed

23.

Vachiramon A, Wang WC, Vachiramon T (2004) The use of acupuncture in implant dentistry. Implant Dent 13(1):58–64CrossRefPubMed

24.

Aickin M, Gensler H (1996) Adjusting for multiple testing when reporting research results: the Bonferroni vs Holm methods. Am J Public Health 86(5):726–728CrossRefPubMedPubMedCentral

Title: The gagging patient in ORL examinations: predictors, evaluation and treatment
Authors: David Zuschlag
Philipp Kulas
Bernhard Schick
Alessandro Bozzato
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Laryngoscopy
Laryngoscopy
Published in: European Archives of Oto-Rhino-Laryngology / Issue 6/2019
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-019-05404-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The gagging patient in ORL examinations: predictors, evaluation and treatment

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 6/2019

Reconstruction of complex defects of the extracranial facial nerve: technique of “the trifurcation approach”

The effect of lidocaine and tramadol in nasal packs on pain after septoplasty

Voice rehabilitation for laryngeal cancer after radiotherapy: a systematic review and meta-analysis

Radioguided occult lesion localization in patients with recurrent thyroid cancer

Increased TSLP, IL-33, IL-25, IL-19, IL 21 and amphiregulin (AREG) levels in chronic rhinosinusitis with nasal polyp

Correlation between olfactory function, trigeminal sensitivity, and nasal anatomy in healthy subjects