Explore 5-Minute Clinical Consult - view these FREE monographs:
-- The first section of this topic is shown below --
- Hiccups are caused by a sudden involuntary contraction of the inspiratory muscles (predominantly the diaphragm) terminated by abrupt closure of the glottis, stopping the inflow of air and producing the characteristic sound (1).
- System(s) affected: Nervous; Pulmonary
- Synonym(s): Hiccoughs; Singultus
Can be a serious problem among the elderly
- Fetal hiccups are noted as rhythmic fetal movements (confirmed sonographically) that can be confused with contractions.
- Fetal hiccups often recur in subsequent pregnancies.
- Predominant age: All ages (including fetus)
- Predominant sex: Male > Female (4:1)
Self-limited hiccups are extremely common, as are intra- and postoperative hiccups; intractable hiccups are rare.
- General anesthesia; conscious sedation
- Postoperative state
- Genitourinary disorders
- Irritation of the vagus nerve branches
- Structural, vascular, infectious, neoplastic, or traumatic CNS lesions
- Identify and correct the underlying cause.
- Avoid gastric distention.
- Seek medical attention for frequent bouts or persistent hiccups.
- Acupuncture appears to be as or more efficacious than chronic drug therapy to control hiccups.
- Pathophysiologic significance is unknown; may be a vestigial reflex; hiccups have been associated with >100 underlying disorders (1). The latest theory suggests hiccups function to remove swallowed gas from the stomach as a burping reflex (2)
- Results from stimulation of ≥1 limbs of the hiccup reflux arc (vagus and phrenic nerves) with a “hiccup center” located in the upper spinal cord
- In men, >90% have an organic basis, whereas in women a psychogenic cause may be more likely.
- Specific underlying causes include:
- CNS lesions (brain-stem tumors, vascular lesions, Parkinson disease) (3)
- Diaphragmatic irritation (tumors, pericarditis, eventration, splenomegaly, hepatomegaly, peritonitis)
- Hair, insect, or foreign body irritating tympanic membrane
- Pharyngitis, laryngitis
- Mediastinal and other thoracic lesions (pneumonia, aortic aneurysm, tuberculosis [TB], myocardial infarction [MI], lung cancer, rib exostoses)
- Esophageal lesions (reflux esophagitis, achalasia, Candida esophagitis, carcinoma, obstruction)
- Gastric lesions (ulcer, distention, cancer)
- Hepatic lesions (hepatitis, hepatoma)
- Pancreatic lesions (pancreatitis, pseudocysts, cancer)
- Inflammatory bowel disease
- Cholelithiasis, cholecystitis
- Prostatic disorders
- Postoperative, abdominal procedures (4)
- Toxic metabolic causes (uremia, hyponatremia, gout, diabetes)
- Drug-induced (dexamethasone, methylprednisolone, anabolic steroids, benzodiazepines, α-methyldopa, propofol)
- Psychogenic causes (hysterical neurosis, grief, malingering)
Commonly Associated Conditions