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The "Polite Yawning" Technique

Frans J. M. Hilgers, MD, PhD; Frits S. A. M. van Dam, PhD; Saskia Keyzers, MSc; Marike N. Koster; Corina J. van As, MSc; Martin J. Muller, MSc

Arch Otolaryngol Head Neck Surg. 2000;126:726-732.

Objective  To develop a nasal airflow-inducing maneuver and apply it in the olfactory rehabilitation of patients who have undergone laryngectomy.

Design  Intervention study; before-and-after trial.

Setting  National cancer center.

Patients  Forty-four patients who underwent laryngectomy; 34 men and 10 women; mean age, 64 years (range, 42-80 years); mean time since surgery, 6 years (range, 8 months to 18 years).

Intervention  In a prospective clinical intervention study, we assessed the effectiveness of a nasal airflow-inducing maneuver ("polite yawning," ie, yawning with closed lips). Speech therapists trained the patients in the maneuver, and its effectiveness in inducing nasal airflow was checked with digital and water manometers.

Main Outcome Measures  Olfactory acuity was assessed before and after the intervention by means of an odor detection test and a structured questionnaire concerning olfaction, taste, and appetite. Patients were categorized as "smellers" and "nonsmellers" on the basis of the results of the odor detection test and the present odor perception scale derived from the questionnaire.

Results  The nasal airflow-inducing maneuver could be taught to all patients, mostly in only one 30-minute therapy session. Fifteen of the 33 patients in the pretreatment nonsmeller category converted to smellers, for a success rate of 46% (P<.001).

Conclusion  The nasal airflow-inducing maneuver (the "polite yawning" technique) allowed almost half of the patients to recover their sense of smell.

From the Department of Otolaryngology/Head and Neck Surgery, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Dr Hilgers and Mss Koster and van As); and Department of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute and Department of Clinical Psychology, Faculty of Psychology, University of Amsterdam (Dr van Dam, Ms Keyzers, and Mr Muller).

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