Singultus / Hiccups
Almost everyone has had hiccups. Some people even have them before they're born. "Singultus" is the medical term for hiccups, derived from the Latin word "singult," which means the act of catching your breath while sobbing, an apt description of the way hiccups sound. Although they can be embarrassing — especially if the "hic" pops out of your mouth in a quiet room or during a meeting — hiccups are rarely cause for concern.
Often, there's no obvious cause for hiccups. Sometimes they may be the result of eating a large meal, drinking a carbonated beverage or sudden excitement. Rarely, hiccups may be a sign of an underlying medical condition.
Hiccups usually disappear on their own. If your hiccups don't go away after a few minutes, home remedies may help. If hiccups persist for more than 48 hours or if they are so severe that they interfere with eating or breathing, see your doctor.
A hiccup is an unintentional contraction of your diaphragm — the muscle that separates your chest from your abdomen and plays an important role in breathing. This contraction makes your vocal cords close very briefly, which produces the sound of a hiccup.
Acute or transient hiccups
Although there's often no clear cause for a bout of hiccups, some factors that can trigger acute or transient hiccups include :
- Eating spicy food. Spicy food may cause irritation to the nerves that control normal contractions of your diaphragm.
- Eating a large meal, drinking carbonated beverages or swallowing air. These can cause your stomach to expand (distend), which pushes up your diaphragm, making hiccups more likely.
- Drinking alcohol. Alcohol can relax your diaphragm and vocal cords, making it easier for other factors to trigger hiccups.
- Sudden temperature changes. A quick change in temperature, either inside or outside your body, such as drinking hot liquids and then cold liquids or your shower water switching suddenly from hot to cold, can set off hiccups.
- Tobacco use. Tobacco use may irritate the nerves that controls the diaphragm (phrenic nerves), causing hiccups.
- Sudden excitement or emotional stress. Although it's not clear why stress or sudden excitement causes hiccups, it may be due to the effect being startled has on one of the nerves involved in the hiccup reflex (vagus nerves).
Persistent and intractable hiccups
Rarely, hiccups may be the result of an underlying medical condition. When this is the case, the hiccups usually last longer than 48 hours. More than 100 causes of persistent and intractable hiccups have been identified. They are generally grouped into the following categories :
Nerve damage or irritation. Damage or irritation of one of your vagus nerves or phrenic nerves is the most common cause of persistent or intractable hiccups.
The vagus nerve serves as a communication pathway between your brain and organs, such as your heart, lungs and intestines. There's one vagus nerve on each side of your body. These nerves run from your brainstem through your neck and down to your chest and abdomen. The phrenic nerve controls movement of your diaphragm. There's one phrenic nerve on each side of your body. The phrenic nerves run from your brainstem through your neck and down to your diaphragm.
Examples of conditions that may damage or irritate these nerves include a foreign body (often a hair) in your ear, a tumor, cyst or goiter in your neck or chest, gastroesophageal reflux, or an abscess on your diaphragm.
- Central nervous system disorders. A tumor or infection in your central nervous system, or damage to your central nervous system as a result of trauma, can release your body's normal control of the hiccup reflex.
- Metabolic disorders. Metabolic disorders that may cause hiccups include a condition that interferes with the ability of your kidneys to keep wastes from building to toxic levels (uremia) and a condition that results in less than the normal levels of carbon dioxide in your blood (hypocapnia).
- Surgery. General anesthesia and complications following surgery can cause intractable hiccups.
- Mental or emotional triggers. Anxiety, stress and excitement have been associated with some cases of persistent or intractable hiccups.
Risk factors :
If you use tobacco or drink alcohol regularly, you may get transient hiccups more often than people who don't. Men are more likely to have persistent or intractable hiccups.
When to seek medical advice :
Make an appointment to see your doctor if your hiccups last more than 48 hours or if they are so severe that they cause problems with eating or breathing.
The characteristic sound of a hiccup, sometimes preceded by a small tightening sensation in your chest, abdomen or throat, are the only signs and symptoms associated with hiccups. People may have as few as four hiccups a minute or, rarely, as many as 60 hiccups a minute.
How long your hiccup episode lasts determines the type of hiccups you have :
- Transient or acute hiccups. This is the most common form of hiccups. Transient hiccups include hiccup episodes that last less than 48 hours. Most bouts of transient hiccups last only a few minutes.
- Persistent hiccups. These hiccups last longer than 48 hours, but less than a month.
- Intractable hiccups. Hiccups fall into this category when they last more than two months.
For hiccups lasting longer than 48 hours, your doctor will perform a physical exam and talk with you about your medical history. If your doctor suspects an underlying medical condition may be causing your hiccups, he or she may recommend one or more of the following tests :
- Blood tests. A laboratory exam of a blood sample may help reveal an infection, metabolic disorder or tumor.
- Chest X-ray. A chest X-ray may detect abnormalities affecting the vagus nerve, phrenic nerve or diaphragm.
- Ear exam. Examination of the external ear canal may reveal a foreign substance in your ear that could be causing your hiccups.
- Fluoroscopy. This exam is a type of X-ray that uses low-dose radiation to produce images of a body part in motion. Fluoroscopy can show if one side (unilateral) or both sides (bilateral) of your diaphragm are being affected by hiccup contractions. The results of fluoroscopy can help rule out some underlying medical conditions.
If the cause of your hiccups remains unclear after these tests, additional tests may be necessary, depending on your condition.
Most cases of hiccups go away on their own, without medical treatment. If an underlying medical condition is causing your hiccups, treatment of that illness may eliminate the hiccups. If your hiccups are persistent or intractable, your doctor may recommend the following Treatment:
- Medication. Several forms of medication may be effective for treating hiccups. The most commonly used is chlorpromazine (Thorazine). Other medications that may be helpful include metoclopramide (Reglan), anticonvulsants, benzodiazepines and baclofen (Lioresal).
- Carotid sinus massage. Your carotid sinus is located in your neck, just below your jaw and just above the point where your carotid artery — a blood vessel that supplies blood to your brain — divides into its two main branches. Massage of your carotid sinus may help eliminate hiccups. This hiccups treatment should be performed only by your health care provider. Don't try carotid massage at home: It can be dangerous.
- Nasogastric (NG) tube. If your stomach is distended, a thin, flexible tube inserted through your nose and into your stomach (nasogastric tube) may stop hiccups by providing relief from stomach distention. The tube usually is removed as soon as the hiccups stop.
- Nerve block. Rarely, if other treatments aren't effective, your doctor may recommend an injection of an anesthetic to block your phrenic nerve to stop hiccups.
You may be able to decrease your frequency of transient or acute hiccups by avoiding common hiccup triggers, such as eating quickly, eating large meals or spicy foods, drinking carbonated beverages or alcohol, sudden changes in temperature, and using tobacco.