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SUMMARY: Sulemanji MN, Kanbur NO, Derman O, Pehlivantiirk B, Hosal SA, Sekerel BE. Intractable sneezing: is it always psychogenic? Turk J Pediatr 2011; 53: 225-228.
Intractable sneezing is not a commonly encountered disorder. The clinical presentation of such patients may cause the physician to undertake several tests before making a diagnosis. Are the performed analytic tests a waste of the health service funds or are they really sufficient? In this case, after undergoing several tests to rule out potential causes of the prevailing symptoms, psychiatric evaluation revealed a triggering event that contributed to the diagnosis of psychogenic sneezing. This specific case demonstrates why the diagnosis of psychogenic sneezing is difficult. An overwhelming number of such patients may be linked to a psychogenic cause; nevertheless, organic lesions or causes should be carefully excluded. Addressing the psychosocial issues through psychotherapy and coincidental use of locally administered anesthesia assisted in resolving the symptoms.
Key words: intractable sneezing, conversion disorder, topical nasal anesthesia, psychogenic, adolescents.
Intractable paroxysmal sneezing has been described and reported as an unusual disorder. Typical episodes of sneezing, manifested as 'pseudo-sneezes', occur with atypical frequency and rhythm, with eyes open, and are usually absent during sleep or when the patient is alone. This can be construed as a manifestation of conversion disorder. Since 1949, when it was first reported by Shilkret1, an overwhelming majority of these cases have been reported to have a psychogenic origin, primarily affecting female adolescents. Approximately 25% of the reported cases resolve without any form of treatment, except counseling of the patient and family1. We present here a case of intractable sneezing who tested negative for any organic lesion and for which a specific provoking psychosocial event was uncovered; hence, the diagnosis of conversion disorder was considered. A resolving response to local administration of pantocaine during rhinoscopic examination prior to psychiatric interview aroused our interest about the nature of the disorder. We discuss herein the diagnostic difficulties and whether the use of local anesthetic had any effect on the treatment of the symptoms.
Case Report
An 11 -year-old female patient was seen in the adolescent outpatient clinic for the evaluation of intractable sneezing. Her sneezing episodes dated back two weeks and she had been examined by primary care physicians, who...