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Runggaldier D, Adam R, Ermanni C, Colotto-Vith U, van Beek MEF, Posovszky C, Righini Grunder F, Pohl D, Bohlender JE. [Gastric vs. supragastric belching, singultus, aerophagia, and differential diagnoses : An interdisciplinary perspective for otorhinolaryngologists]. HNO 2024; 72:657-667. [PMID: 38935275 PMCID: PMC11339109 DOI: 10.1007/s00106-024-01495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 06/28/2024]
Abstract
Belching is the act of expelling air from the stomach or esophagus into the pharynx. Although the process is regarded as physiological, excessive belching might be associated with a significant burden for affected patients in the sense of a belching disorder. Diagnosis of a belching disorder is often challenging, and its differentiation from other conditions such as rumination syndrome, singultus, or aerophagia can be difficult. Treatment of these disorders also represents a challenge for otorhinolaryngologists. Hence, the aim of this review is to provide an interdisciplinary overview of these clinical syndromes and provide practical guidance for their diagnosis and treatment.
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Affiliation(s)
- Daniel Runggaldier
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz.
- Universität Zürich, Zürich, Schweiz.
| | - Roman Adam
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Chiara Ermanni
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
| | - Ursula Colotto-Vith
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Miriam E F van Beek
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
| | - Carsten Posovszky
- Gastroenterologie, Hepatologie und Ernährung, Universitäts-Kinderspital Zürich, Zürich, Schweiz
| | - Franziska Righini Grunder
- Gastroenterologie, Hepatologie und Ernährung, Universitäts-Kinderspital Zürich, Zürich, Schweiz
- Gastroenterologie, Hepatologie und Ernährung, Kinderspital Zentralschweiz, Luzern, Schweiz
| | - Daniel Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Jörg E Bohlender
- Klinik für Otorhinolaryngologie, Head and Neck Surgery, Abt. Phoniatrie und Klinische Logopädie, Universitätsspital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Schweiz
- Universität Zürich, Zürich, Schweiz
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Stacey SK, Bassett MS. Hiccup Relief Using Active Prolonged Inspiration. Cureus 2024; 16:e53045. [PMID: 38410321 PMCID: PMC10895902 DOI: 10.7759/cureus.53045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Background Hiccups are a common physiologic reflex resulting from intermittent and involuntary spasmodic contraction of the diaphragm and intercostal muscles. While most cases are self-limited, lasting less than 48 hours, rare pathologies may result in prolonged symptoms. Hiccups can be disruptive and uncomfortable, leading many to seek management strategies using common home remedies. Few methods for terminating hiccups have been published in the scientific literature. We report the efficacy of the Hiccup relief using Active Prolonged Inspiration (HAPI) technique, which combines phrenic and vagal nerve stimulation with transient hypercapnia for hiccup relief. Methods Twenty patients with self-limited hiccups and one patient with prolonged hiccups were successful in eliminating hiccups using HAPI. In this method, patients are instructed to inspire maximally. Once at the peak of inspiration, they continue to attempt to inspire with an open glottis for a total of 30 seconds. This is followed by a slow expiration and resumption of normal respiration. Results In all cases, patients reported immediate hiccup relief. Conclusion These findings suggest the HAPI technique is a simple and viable method for hiccup relief. Further studies are needed to validate effectiveness.
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Affiliation(s)
- Stephen K Stacey
- La Crosse-Mayo Family Medicine Residency Program, Mayo Clinic Health System, La Crosse, USA
| | - Michael S Bassett
- La Crosse-Mayo Family Medicine Residency Program, Mayo Clinic Health System, La Crosse, USA
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Wang J, Wu B, Li Y, Wang X, Lu Z, Wang W. Acupuncture in the treatment of post-stroke hiccup: A systematic Review and meta-analysis. Libyan J Med 2023; 18:2251640. [PMID: 37644765 PMCID: PMC10469484 DOI: 10.1080/19932820.2023.2251640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
Aim: Central hiccups following a stroke are a frequent complication, exerting adverse effects on both the stroke condition and the patient's daily life. Existing treatments exhibit limited efficacy and pronounced side effects. Acupuncture has been explored as a supplementary intervention in clinical practice. This study aims to investigate the clinical effectiveness of acupuncture for post-stroke hiccups.Methods: To identify published clinical randomized controlled trials addressing post-stroke hiccups treatment, comprehensive searches were conducted across PubMed, the Cochrane Library, EMBASE, Web of Science, Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP). In addition, we scrutinized ClinicalTrials.gov and the Chinese Clinical Trial Registry. Employing Cochrane Handbook 5.1.0 and Review Manager 5.4 software, three authors independently reviewed literature, extracted data, and evaluated study quality. Data analysis was performed using Stata 16.0 and Review Manager 5.4.Results: A total of 18 trials were encompassed in the analysis. In comparison to standard treatment, acupuncture exhibited a significant enhancement in treatment effectiveness (RR: 1.27, 95% CI: 1.21-1.33; P < 0.00001). Notably, Hiccup Symptom Score displayed a considerable decrease (WMD: -1.28, 95% CI: -1.64 to -0.93; P < 0.00001), concurrent with a noteworthy improvement in the quality of life (WMD: 8.470, 95% CI: 7.323-9.617; P < 0.00001). Additionally, the incidence of adverse reactions decreased (RR: 0.45, 95% CI: 0.16-1.25; P = 0.13), and there was a significant reduction in SAS (WMD: -7.23, 95% CI: -8.47 - -5.99; P < 0.00001).Conclusions: Our investigation suggests that acupuncture could prove effective in post-stroke hiccup treatment. Nonetheless, due to concerns about the quality and size of the included studies, conducting higher-quality randomized controlled trials to validate their efficacy is imperative.
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Affiliation(s)
- Jiaqi Wang
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bangqi Wu
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yibing Li
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xuhui Wang
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhaojun Lu
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wenqing Wang
- Acupuncture Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Niedermeyer S, Greve T, Lamm LM, Thorsteinsdottir J, Schichor C, Tonn JC, Szelényi A. Acute Hiccups Detected by Electromyographic Recordings During Resection of a Vestibular Schwannoma. Oper Neurosurg (Hagerstown) 2022; 23:e298-e303. [PMID: 36106939 DOI: 10.1227/ons.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Intraoperative neuromonitoring (IONM) is routinely used to monitor cranial nerve function during resection of vestibular schwannomas. Sudden movements in the surgical field can be a disturbing factor for the surgeon. IONM can help determine the cause of unexpected patient movements. CLINICAL PRESENTATION We report the case of a 54-year-old patient who underwent retromastoid craniotomy and resection of a vestibular schwannoma. Toward the end of dissection of the tumor from the lower cranial nerves and brainstem, the patient showed repetitive shoulder elevation. Electroencephalography showed burst suppression, confirming deep sedation and excluding voluntary movements. Free-running electromyography recorded spontaneous, simultaneous, bilateral vocal cord activity that was synchronous with upper body movement. There was simultaneous but smaller activity in the right genioglossus muscle and levator veli palatini, indicative for far-field activity. These IONM findings allowed us to classify the clinical observations as intraoperative hiccups. CONCLUSION Hiccups during general anesthesia are rare but should be considered as a differential diagnosis of sudden upper body movement. To the best of our knowledge, this is the first reported case of acute hiccups during resection of a vestibular schwannoma. IONM reliably distinguished it from an increase in intraoperative consciousness or accessory nerve activation resulting in shoulder movements.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Greve
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ludwig-Maximilian Lamm
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Szelényi
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Mustafa R, Neth BJ, Stitt D. Bilateral Vagus Nerve Enhancement in a Patient With Leptomeningeal Lymphoplasmacytic Lymphoma Presenting with Intractable Hiccups. JAMA Neurol 2021; 78:493-494. [PMID: 33369636 DOI: 10.1001/jamaneurol.2020.4830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rafid Mustafa
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Bryan J Neth
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Derek Stitt
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Tariq K, Das JM, Monaghan S, Miserocchi A, McEvoy A. A case report of Vagus nerve stimulation for intractable hiccups. Int J Surg Case Rep 2020; 78:219-222. [PMID: 33360634 PMCID: PMC7773651 DOI: 10.1016/j.ijscr.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
Intractable hiccups are associated with significant morbidity and may lead to mortality. Several medical, pharmacological, surgical and novel treatment options are available. Vagus nerve stimulator placement is a novel surgical option for the treatment of intractable hiccups. Vagus nerve stimulator is currently not approved for the indication of intractable hiccups.
Introduction Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. Presentation of the case An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. Discussion A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. Conclusion VNS insertion is a novel surgical option for the treatment of intractable hiccups.
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Affiliation(s)
- Kanza Tariq
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK.
| | - Joe M Das
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Sasha Monaghan
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Anna Miserocchi
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Andrew McEvoy
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
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Petroianu GA, Lorke DE. The Role of Serotonin in Singultus: A Review. Front Neurosci 2020; 14:629. [PMID: 32765206 PMCID: PMC7378791 DOI: 10.3389/fnins.2020.00629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Georg A. Petroianu
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
- *Correspondence: Georg A. Petroianu,
| | - Dietrich E. Lorke
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Taylor RJ, Lowe SR, Ellis N, Abdullah E, Patel S, Halstead LA. Laryngeal manifestations of cranial nerve IX/X compression at the brainstem. Laryngoscope 2018; 129:2105-2111. [PMID: 30582168 DOI: 10.1002/lary.27678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/09/2018] [Accepted: 10/22/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We report an association between lower cranial nerve (CN IX/X) vascular compression at the brainstem with laryngeal symptoms utilizing a stepwise algorithm that systematically evaluates and eliminates all other common etiologies. Our experiences with retromastoid craniectomy with lower cranial nerve (LCN) decompression versus non-neurosurgical treatments are detailed. STUDY DESIGN Retrospective chart review at a tertiary care academic medical center with follow-up telephone survey. METHODS Baseline demographics, clinical characteristics, quality-of-life surveys, and treatment outcomes were recorded for patients with laryngeal symptoms associated with LCN compression at the brainstem. RESULTS Forty-nine patients demonstrated LCN compression at the brainstem on imaging and presented with chief complaints of dysphonia (25 of 49, 51%), chronic cough (19 of 49, 39%), dysphoric breathing (3 of 49, 6%), and dysphagia (2 of 49, 4%). Poor initial scores were noted for Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index, and Glottal Closure Index. Twenty-four patients underwent LCN decompression, of which 21 of 24 (88%) reported partial, near-complete, or complete improvement. Major perioperative complications occurred in four of 24 patients (17%). Patients who had undergone decompression were more likely to obtain complete/near-complete symptom resolution (10 of 24 patients, 42%) compared to those undergoing conservative treatments (2 of 25 patients, 8%) (P = 0.02). V-RQOL scores improved more in surgical patients [mean change score, 33.0 (standard deviation [SD], 31.2) than nonsurgical patients (mean change score 9.6, SD 20.9) (P = 0.03) (mean follow-up 3.0 years, SD 2.0). CONCLUSION Lower cranial nerve compression at the brainstem should be considered when all other etiologies are excluded. Retromastoid craniectomy with LCN decompression demonstrates an acceptable safety profile. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2105-2111, 2019.
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Affiliation(s)
- Robert J Taylor
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Stephen R Lowe
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Nic Ellis
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Evan Abdullah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Sunil Patel
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Lucinda A Halstead
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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De Vloo P, Dallapiazza RF, Lee DJ, Zurowski M, Peng PW, Chen R, Hodaie M. Long-term relief of intractable hiccups with vagal nerve stimulation. Brain Stimul 2018; 11:1385-1387. [PMID: 30146427 DOI: 10.1016/j.brs.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Philippe De Vloo
- Division of Neurosurgery, Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Robert F Dallapiazza
- Division of Neurosurgery, Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Darrin J Lee
- Division of Neurosurgery, Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Mateusz Zurowski
- Division of Psychiatry, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Philip W Peng
- Divison of Anesthesiology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Robert Chen
- Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada; Krembil Brain Institute, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada; Krembil Brain Institute, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada.
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Grewal SS, Adams AC, Van Gompel JJ. Vagal nerve stimulation for intractable hiccups is not a panacea: a case report and review of the literature. Int J Neurosci 2018; 128:1114-1117. [DOI: 10.1080/00207454.2018.1486307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Sanjeet S. Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Teles LMF, Neto ID, Macedo BLF, Montira F. Intractable hiccups as the presenting symptom of toxic nodular goiter. Porto Biomed J 2018; 3:e19. [PMID: 31595247 PMCID: PMC6726289 DOI: 10.1016/j.pbj.0000000000000019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/01/2018] [Indexed: 11/28/2022] Open
Abstract
Hiccups differential diagnosis is a challenging one often being inconclusive and sometimes attributed to malignancies, and so of extreme importance to an internist. Seventy-five-year-old man with history of alcohol abuse, hypertension, and hyperlipidemia presented to the emergency department after having initiated diarrhea, hiccups, and vomiting for 4 days. Physical examination revealed signs of dehydration and persistent hiccups at rest. Laboratory investigations revealed acute renal failure (creatinine 3.7 mg/dl, reference value: 0.7–1.3 mg/dl; urea 195 mg/dl, reference value: 18–55 mg/dl) and no elevation of inflammatory parameters. Findings were consistent with a gastroenteritis, it was started fluids and the patient was admitted in the internal medicine ward. As the gastroenteritis symptoms ceased and the acute renal failure was resolved, the hiccups continued and physical examination revealed 2 palpable thyroid nodules. Laboratory findings shew subclinical hyperthyroidism (serum TSH 0.02 uUI/ml, reference value: 0.35 –4.94 uUI/ml; free T4 levels 18.5 pmol/L, reference value: 9.0–19 pmol/L). It was conducted an ultrasonography that revealed an increase of thyroid dimensions and 2 nodules. One nodule in the right lobe with 32 mm of dimension and one nodule in the left lobe with 58 mm of dimension. Both nodules were hypoechoic. Patient started antithyroid medication with propylthiouracil (PTU), 200 mg every 12 hours, and a cervical CT scan was conducted. CT scan revealed images compatible with diving goiter (Fig. 1) and tracheal deviation, for the right side (Fig. 2), inducted by the thyroid left nodule. Patient was discharged with antithyroid medication and hiccups were meliorated with chlorpromazine although persisting. After thyroid function normalization thyroidectomy was conducted, a few months later, and hiccups ceased.
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Affiliation(s)
- Luís Miguel Fernandes Teles
- Internal Medicine Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Inês Domingues Neto
- Internal Medicine Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bernardo Luís Fernandes Macedo
- Internal Medicine Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Fernando Montira
- Internal Medicine Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
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Errico J. The Role of Vagus Nerve Stimulation in the Treatment of Central and Peripheral Pain Disorders and Related Comorbid Somatoform Conditions. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care 2017; 8:1-6. [DOI: 10.1136/bmjspcare-2016-001264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 11/03/2022]
Abstract
Persistent hiccups are a frustrating experience for palliative care patients, and can have a profound impact on their quality of life. This article provides an evidence-based approach overview of the causes and treatment of this not infrequently debilitating condition for such patients, with a management algorithm. In situations where no readily reversible cause is identified, or where simple physical manoeuvres, such as breath holding have failed, a systematic approach is required. Hiccups can be broadly divided into central and peripheral types. These respond differently to pharmacological intervention. The drug of choice for central causes of persistent hiccups is baclofen, with metoclopramide recommended as the first choice for peripheral causes. Midazolam may be useful in cases of terminal illness. Interventional procedures such as vagal or phrenic nerve block or stimulation should be considered in patients who are refractory to medications. The management of persistent hiccups still presents an ongoing clinical challenge however, requiring further research on pathophysiology and treatment strategies. Multinational randomised controlled trials to evaluate and compare both current and new medications or procedures to better manage this difficult condition are suggested as a means of reaching this goal.
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García Callejo FJ, Redondo Martínez J, Pérez Carbonell T, Monzó Gandía R, Martínez Beneyto MP, Rincón Piedrahita I. Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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García Callejo FJ, Redondo Martínez J, Pérez Carbonell T, Monzó Gandía R, Martínez Beneyto MP, Rincón Piedrahita I. Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:98-105. [PMID: 27542994 DOI: 10.1016/j.otorri.2016.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations. PATIENTS AND METHODS This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%). RESULTS A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders -mainly gastroesophageal reflux- were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died. CONCLUSIONS Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.
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Affiliation(s)
| | - Jaume Redondo Martínez
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Tomás Pérez Carbonell
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Rafael Monzó Gandía
- Servicio de Otorrinolaringología, Hospital General de Requena, Requena, Valencia, España
| | - M Paz Martínez Beneyto
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - Inés Rincón Piedrahita
- Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España
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Kumar R, Winston KR, Folzenlogen Z. Removal of Vagus Nerve Stimulator Leads and Reuse of Same Site for Reimplantation: Technique and Experience. World Neurosurg 2016; 91:190-4. [PMID: 27062916 DOI: 10.1016/j.wneu.2016.03.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This report describes the authors' experience and technique in removing vagus nerve stimulator leads, including coils, and reuse of the same site on the vagus nerve for implantation of new coils. METHODS The charts of all patients who underwent complete removal by the authors of vagus nerve stimulator leads between 1 September 2001 and 1 July 2015 were retrospectively reviewed. RESULTS Thirty patients underwent 31 surgeries for removal of vagus nerve stimulator leads. Complete removal, including proximal coils around the vagus nerve, was achieved in all cases. Reimplantation was performed immediately at the same location in 24 patients, delayed in 1 patient, and never replaced in 6. Long-term vocal cord paralysis followed 2 of 9 surgeries performed with sharp dissection and followed one of 22 surgeries in which dissection was performed with monopolar microneedle electrocautery. CONCLUSIONS Vagus nerve stimulator coils can be removed from the vagus nerve, via monopolar microneedle electrocautery, and the same site reused for immediate reimplantation with relative safety.
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Affiliation(s)
- Ramesh Kumar
- Department of Neurosurgery of the University of Colorado School of Medicine, Aurora, Colorado, USA; Denver Health and Hospitals, Denver, Colorado, USA; University Hospital Colorado, Aurora, Colorado, USA; Children's Hospital Colorado, Aurora, Colorado, USA.
| | - Ken R Winston
- Department of Neurosurgery of the University of Colorado School of Medicine, Aurora, Colorado, USA; Denver Health and Hospitals, Denver, Colorado, USA; University Hospital Colorado, Aurora, Colorado, USA; Children's Hospital Colorado, Aurora, Colorado, USA
| | - Zach Folzenlogen
- Department of Neurosurgery of the University of Colorado School of Medicine, Aurora, Colorado, USA; University Hospital Colorado, Aurora, Colorado, USA; Children's Hospital Colorado, Aurora, Colorado, USA
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Goldin M, Hahn Z. A hiccup in holiday plans. BMJ Case Rep 2016; 2016:bcr-2015-213288. [PMID: 26822498 DOI: 10.1136/bcr-2015-213288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mark Goldin
- North Shore-LIJ Health System, New Hyde Park, New York, USA
| | - Zachary Hahn
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA
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20
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Petree K, Bruner J. Postoperative Singultus: An Osteopathic Approach. J Osteopath Med 2015; 115:166-8. [DOI: 10.7556/jaoa.2015.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Singultus, or hiccups, is a common medical condition. Despite exponential leaps in medicine, the pathophysiologic cause remains poorly defined. Persistent singultus has been associated with conditions such as pulmonary embolism and myocardial infarction. Singultus is also a well-known postoperative complication. The criterion standard of care for patients with singultus involves ruling out lethal pathologic causes, attempting physical stimulation with Valsava maneuvers or drinking water, and, if no relief has been achieved, administering drugs to ease the symptoms. The authors report a case of a man whose postoperative singultus was successfully managed with osteopathic manipulative treatment. This approach addresses many of the possible underlying neuromechanical causes of the aberrant reflex with minimal potential for adverse effects. Physicians should consider osteopathic manipulative treatment in the care of patients with singultus.
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Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 4:S614-8. [PMID: 25716660 DOI: 10.1007/s00586-015-3822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/15/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hiccups caused by a neoplasm in the spinal cord are rare. MATERIALS AND METHODS We report a case of intractable hiccups caused by syringobulbia and syringomyelia associated with cervical intramedullary spinal hemangioblastoma, which was successfully treated by surgical excision. A 60-year-old man was referred from the neurology department after presenting with hiccups for 1 year. The hiccups were aggravated 3 months ago and were sustained during eating or sleeping. Several doctors administered a muscle relaxant and an anticonvulsant, but they were ineffective. Spinal MRI revealed a huge syringomyelia from C2 to T2, associated with a highly enhancing intramedullary mass lesion at the C5 level. The hiccups were ceased after removal of the tumor through a right hemilaminectomy. The pathology of the specimen was hemangioblastoma. The size of the syringobulbia and syringomyelia decreased markedly on MRI checked 5 months after surgery. CONCLUSIONS Intractable hiccups can be caused by syringobulbia associated with an intramedullary cord tumor in the cervical area and possible mechanisms of hiccups were reviewed.
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Robinson LC, Winston KR. Relationship of vocal cord paralysis to the coil diameter of vagus nerve stimulator leads. J Neurosurg 2014; 122:532-5. [PMID: 25526267 DOI: 10.3171/2014.10.jns14640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This investigation was done to examine, following implantation of vagus nerve stimulators, the relationship of vocal cord paralysis to the inner diameter of the coils used to attach the stimulator lead to the nerve. METHODS All data in this investigation were collected, as mandated by the FDA, by the manufacturer of vagus nerve stimulators and were made available without restrictions for analysis by the authors. The data reflect all initial device implantations in the United States for the period from 1997 through 2012. RESULTS Vocal cord paralysis was reported in 193 of 51,882 implantations. In patients aged 18 years and older, the incidence of paralysis was 0.26% when the stimulator leads had coil diameters of 3 mm and 0.51% when the leads had 2-mm-diameter coils (p < 0.05). Across all age groups, the incidence of vocal cord paralysis increased with age at implantation for leads having 2-mm-diameter coils. CONCLUSIONS In patients aged 18 years and older, vocal cord paralysis occurred at almost twice the rate with the implantation of vagus nerve stimulator leads having 2-mm-diameter coils than with leads having 3-mm-diameter coils. The incidence of vocal cord paralysis increases with patient age at implantation.
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Affiliation(s)
- Leslie C Robinson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora
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Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F. Gastrointestinal complications after ischemic stroke. J Neurol Sci 2014; 346:20-5. [PMID: 25214444 DOI: 10.1016/j.jns.2014.08.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 01/25/2023]
Abstract
Ischemic stroke is an important cause of morbidity and mortality, and currently the leading cause of adult disability in developed countries. Stroke is associated with various non-neurological medical complications, including infections and thrombosis. Gastrointestinal complications after stroke are also common, with over half of all stroke patients presenting with dysphagia, constipation, fecal incontinence or gastrointestinal bleeding. These complications are associated with increased hospital length of stay, the development of further complications and even increased mortality. In this article we review the epidemiology, pathophysiology, diagnosis, management and prevention of the most common gastrointestinal complications associated with ischemic stroke.
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Affiliation(s)
- Carlos R Camara-Lemarroy
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico.
| | - Beatriz E Ibarra-Yruegas
- Departamento de Psiquiatria, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
| | - Fernando Gongora-Rivera
- Departamento de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico
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Abstract
A multitude of nonpharmacological interventions to terminate hiccup belong to the public-domain hiccup "mythology" or have been described in the medical literature as case reports. While usually effective in terminating bouts of acute hiccup, they are mostly ineffective in cases of hiccupping that have been present for an extended period. The common denominator of most of these therapeutic maneuvers (some also used to terminate paroxysmal supraventricular tachycardia) is their ability to directly or indirectly increase efferent vagal activity. Among the best known "vagal maneuvers" are the oculo-cardiac reflex (Dagnini-Aschner), the carotid sinus massage, the Valsalva maneuver, stimulation of the ear/auditory canal, ice ingestion, and induction of emesis. This short report provides an overview on hiccups and attempts to identify the lesser known personalities who pioneered its treatment by vagal maneuvers. The recent introduction of electrical vagus nerve stimulation for therapy-resistant hiccup is the ultimate compliment to these pioneers.
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Affiliation(s)
- Georg A Petroianu
- a Herbert Wertheim College of Medicine , Florida International University , Miami , FL
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Hurst DF, Purdom CL, Hogan MJ. Use of paced respiration to alleviate intractable hiccups (Singultus): a case report. Appl Psychophysiol Biofeedback 2013; 38:157-60. [PMID: 23568280 DOI: 10.1007/s10484-013-9215-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Heart rate variability (HRV) biofeedback is an emerging treatment for many health conditions involving dysregulation of the autonomic nervous system including hypertension, gastric pain, anxiety, and depression. Hiccups are frequently considered an annoyance. However, when intractable (lasting over 1 month), they can become debilitating, with some patients resorting to invasive treatments that often involve the phrenic nerve. Theoretically, HRV biofeedback should also provide a means to stimulate the phrenic nerve and could be an alternative option. We report the successful treatment of a 5 year-long case of intractable hiccups with one session of HRV biofeedback training. These results suggest that biofeedback may be a useful, non-invasive means of relieving intractable hiccups. No clear causality can be inferred from a single case, and further study is needed to determine if this finding has wider applicability.
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Affiliation(s)
- Duane F Hurst
- Division of Psychology, Mayo Clinic Arizona, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA.
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Rizzo C, Vitale C, Montagnini M. Management of intractable hiccups: an illustrative case and review. Am J Hosp Palliat Care 2013; 31:220-4. [PMID: 23408373 DOI: 10.1177/1049909113476916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Often thought of as a benign and self-limited condition, hiccups can become persistent or intractable, and thus be associated with substantial morbidity and distress. In such cases, an underlying etiology is often present, and may be overlooked. Debilitating hiccups can present a major challenge to optimal symptom management. Various causes of protracted hiccups have been identified including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary and gastrointestinal etiologies. We present a case of intractable hiccups in a patient with an advanced hematological malignancy and review specific therapies for the management of persistent hiccups.
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Affiliation(s)
- Camielle Rizzo
- 1Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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Okada S, Takarabe S, Nogawa S, Abe T, Morishita T, Mori M, Nishida J. Persistent hiccups followed by cardiorespiratory arrest. Lancet 2012; 380:1444. [PMID: 23084457 DOI: 10.1016/s0140-6736(12)60900-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoshi Okada
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan.
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Abstract
Vagus is Latin for wandering, and the vagus nerve fully deserves this name due to its extensive distribution through the body. Indeed, one of the lines of the song that accompanied the 2012 G. L. Brown Prize Lecture exaggerates this diversity, 'My function's almost anythin', and vagus is my name'. Alteration of vagal activity was first investigated in the 1880s as a treatment for epilepsy, and vagus nerve stimulation is now an approved treatment for refractory epilepsy and depression in the USA, despite an incomplete understanding of the mechanisms involved. Vagus nerve stimulation could be beneficial in many other conditions, including heart failure, tinnitus, chronic hiccups, Alzheimer's disease and inflammatory diseases. Inhibition of vagal activity could also be beneficial in some conditions, e.g. reducing activation of vagal respiratory afferents to treat chronic cough. This review discusses evidence underlying some current and potential therapeutic applications of vagal modulation, illustrating the wonders of the Wanderer.
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Affiliation(s)
- Jennifer A Clancy
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK
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29
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Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil 2012; 18:123-30. [PMID: 22523721 PMCID: PMC3325297 DOI: 10.5056/jnm.2012.18.2.123] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/01/2012] [Accepted: 02/10/2012] [Indexed: 11/20/2022] Open
Abstract
Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.
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Affiliation(s)
- Full-Young Chang
- Environmental Health and Safety Office, Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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30
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Treatment of persistent hiccups with transcutaneous phrenic and vagal nerve stimulation. Intensive Care Med 2011; 37:1048-9. [PMID: 21365316 DOI: 10.1007/s00134-011-2150-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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Tay SS, Yadav RR. Novel Use of Baclofen in Cancer Patients for the Treatment of Hiccups. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n2p154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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How Do You Treat Chronic, Continuous Hiccups in Your Practice? Med Acupunct 2009. [DOI: 10.1089/acu.2009.2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Brostoff JM, Birns J, Benjamin E. The "cotton bud technique" as a cure for hiccups. Eur Arch Otorhinolaryngol 2009; 266:775-6. [PMID: 19224234 DOI: 10.1007/s00405-009-0920-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 01/26/2009] [Indexed: 11/26/2022]
Abstract
Persistent hiccups cause psychological and physical distress and can lead to pathology such as carotid artery dissection. Therapy of hiccups is based on small case series, often using pharmacological agents. We present a method that avoids medications or invasive interventions.
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Farin A, Chakrabarti I, Giannotta SL, Vaynman S, Samudrala S. Microvascular decompression for intractable singultus: technical case report. Neurosurgery 2008; 62:E1180-1; discussion E1181. [PMID: 18580793 DOI: 10.1227/01.neu.0000325888.84785.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Intractable singultus is a rare but significantly disruptive clinical phenomenon that often accompanies other diseases but can present in isolation due entirely to intracranial pathology. We report a case of intractable singultus that improved after microvascular decompression and present a comprehensive review of singultus by discussing its similarity to other cases of microvascular decompression, its history and etiology, and its evolutionary basis. CLINICAL PRESENTATION The patient exhibited intractable singultus for 15 years, resistant to multiple medical regimens. INTERVENTION Microvascular decompression to relieve pressure on the tenth cranial nerve and medulla oblongata resulted in near total resolution of the singultus. CONCLUSION Neurovascular compression should be considered a potentially reversible cause of intractable singultus, a significantly disabling clinical phenomenon.
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Affiliation(s)
- Azadeh Farin
- Department of Neurological Surgery, University of Southern California University Hospital, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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35
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Farin A, Chakrabarti I, Giannotta SL, Vaynman S, Samudrala S. MICROVASCULAR DECOMPRESSION FOR INTRACTABLE SINGULTUS. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000310698.49774.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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36
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Amirjamshidi A, Abbassioun K, Parsa K. Hiccup and neurosurgeons: a report of 4 rare dorsal medullary compressive pathologies and review of the literature. ACTA ACUST UNITED AC 2007; 67:395-402; discussion 402. [PMID: 17350413 DOI: 10.1016/j.surneu.2006.10.070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to present 4 rare cases of medullary compressive lesions presenting with IH, to discuss the indications for neurosurgical decompression in such cases, and to review the possible etiologies of IH briefly. METHODS The reported cases include (1) a 19-year-old adolescent boy and a 21-year-old man with Chiari I malformation and cervical syrinx compressing or tightening the cervico-medullary junction; (2) a 35-year-old man with ependymoma extending from the lower half of the fourth ventricle to C1/C2 junction and compressing this part of the medulla; and (3) a 16-year-old adolescent boy who was referred to the emergency department in severe distress because of IH, occurring as a result of a distal PICA aneurysm located on the floor of the lower triangle of the fourth ventricle. RESULTS Surgical decompression in all the cases was successful in withholding the hiccups. CONCLUSION The dorsal medullary area is not an unusual location for genesis of hiccup. When encountering a case of IH, appropriate CNS imaging studies should be included in the evaluation protocol.
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Affiliation(s)
- Abbass Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 19585, Iran.
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37
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Chang CC, Chang ST, Li TY, Chiang SL, Tsai KC, Lin JC. Resolution of Intractable Hiccups after Near-Infrared Irradiation of Relevant Acupoints. Am J Med Sci 2006; 332:93-96. [PMID: 16909058 DOI: 10.1097/00000441-200608000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. METHODS We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. RESULTS The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. CONCLUSIONS This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.
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Affiliation(s)
- Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China..
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Kao-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Jiann-Chyun Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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