Hiccup

Name	Singultus
Icd10
Icd9
Diseasesdb	5887
Medlineplus	003068
Emedicinesubj	emerg
Emedicinetopic	252
Meshid	D006606

A hiccup or hiccough ( ) is a myoclonus of the diaphragm that repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the vocal cords to close, creating a "hic" sound.

In medicine it is known as synchronous diaphragmatic flutter (SDF), or singultus, from the Latin singult, "the act of catching one's breath while sobbing". The hiccup is an involuntary action involving a reflex arc.

Chemotherapy has been implicated in hiccups.

Phylogenetic hypothesis

Christian Straus and co-workers at the Respiratory Research Group, University of Calgary, Canada, propose that the hiccup is an evolutionary remnant of earlier amphibian respiration; amphibians such as tadpoles gulp air and water across their gills via a rather simple motor reflex akin to mammalian hiccuping. In support of this idea, they observe that the motor pathways that enable hiccuping form early during fetal development, before the motor pathways that enable normal lung ventilation form. Thus, according to recapitulation theory (a theory that has lost much of the support it once had) the hiccup is evolutionarily antecedent to modern lung respiration. Additionally, they point out that hiccups and amphibian gulping are inhibited by elevated CO₂ and can be completely stopped by the drug Baclofen (a GABAB receptor agonist), illustrating a shared physiology and evolutionary heritage. These proposals explain why premature infants spend 2.5% of their time hiccuping, indeed they are gulping just like amphibians, as their lungs are not yet fully formed. Fetal intrauterine hiccups are of two types. The physiological type occurs prior to twenty-eight weeks after conception and tend to last five to ten minutes. These hiccups are part of fetal development and are associated with the myelination of the Phrenic nerve (which drives the diaphragm).

Treatment

Ordinary hiccups resolve on their own without medical intervention. However, there are a number of anecdotal treatments for casual cases of hiccups. Some of the more common home remedies include: Drinking water while upside down, giving the afflicted a fright or shock, sticking a finger in the mouth (not in a way that will induce vomiting), massaging the back of the throat (which will stop the irritation in the epiglottis), taking a teaspoon of vinegar, consuming a teaspoon of honey, drinking water from the far side of a glass, drinking a full glass through a paper towel, holding one's breath, breathing deeply followed by swallowing quickly, altering one's breathing patterns, eating a spoonful of peanut butter, drinking hot coffee, or drinking water (in very large amounts) until hiccupping stops.

An anecdotal medical approach is to install Xylocaine liniment 3% or gel 2% in the external ear. Somehow this seems to be able to break a vagus nerve triggering reflex through its extensions to the external ear and Tympanus (Ear drum). The effect can be immediate, and also have lasting effect after the Xylocain effect expires after about two hours.

A solution involving sugar placed on or under the tongue was cited in the December 23, 1971 issue of the New England Journal of Medicine.

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of a 15-year-old girl who, in 2007, hiccuped continuously for five weeks. Haloperidol (Haldol, an anti-psychotic and sedative), metoclopramide (Reglan, a gastrointestinal stimulant), and chlorpromazine (Thorazine, an anti-psychotic with strong sedative effects) are used in cases of intractable hiccups. In severe or resistant cases, baclofen, an anti-spasmodic, is sometimes required to suppress hiccups. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating singultus is done short-term, as the affected individual cannot continue with normal life activities while taking the medication.

Persistent and intractable hiccups due to electrolyte imbalance (hypokalemia, hyponatremia) may benefit from drinking a carbonated beverage containing salt to normalize the potassium-sodium balance in the nervous system. The carbonation promotes quicker absorption. Carbonated beverages by themselves may provoke hiccups in some people.

The administration of intranasal vinegar was found to ease the chronic and severe hiccups of a three-year old Japanese girl. Vinegar may stimulate the dorsal wall of the nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (the afferent of the hiccup reflex arc) is located.

Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental procedure in which a vagus nerve stimulator is implanted in the upper chest of patients with an intractable case of hiccups. "It sends rhythmic bursts of electricity to the brain by way of the vagus nerve, which passes through the neck. The Food and Drug Administration approved the vagus nerve stimulator in 1997 as a way to control seizures in some patients with epilepsy."

Society and culture

American Charles Osborne had the hiccups for 68 years, from 1922 to 1990, and was entered in the Guinness World Records as the man with the longest attack of hiccups.

In 2007, Florida teenager Jennifer Mee gained media fame for hiccuping around 50 times per minute for more than five weeks. A neurologist suggested that she may have had Tourette syndrome, and the hiccups may have been "tics" caused by it, but this has been disputed. Known as "Hiccup Girl", she was arrested after a fatal robbery and accused of murder in October 2010; her attorney suggests that Tourette's Syndrome may be used to defend her case.

Briton Christopher Sands had hiccups for a period of almost three years which were eventually discovered to be due to a tumor located on the part of the brain that controls vascular activity. Once 2/3 of the tumor was removed, the hiccups appeared to lessen, and Sands no longer suffers from the condition.

In Slavic and Baltic folklore, it is said that hiccups occur when the person experiencing them is being talked about by someone not present. Hiccups in Indian folklore are similarly said to occur when the person experiencing them is being thought of by somebody close.

In Plato's Symposium, Aristophanes has a case of the hiccups and is advised by Eryximachus, a physician, to cure them by holding his breath; or, failing that, by gargling or provoking sneezing.

See also

Getting the wind knocked out of you

Sneeze

Cough

Mr. Hiccup

References

Further reading

– hiccup related to reflex in fish and amphibians.

External links

BBC News: Why we hiccup

Category:Symptoms and signs: Circulatory and respiratory systems Category:Onomatopoeias