Hiccup


Hiccup
Singultus
ICD-10 R06.6
ICD-9 786.8
DiseasesDB 5887
MedlinePlus 003068
eMedicine emerg/252
MeSH D006606

A hiccup or hiccough (pronounced /hɪˈkʊp/ hik-UUP or pronounced /ˈhɪkəp/ hik-əp) 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".[1] The hiccup is an involuntary action involving a reflex arc.[1]

A bout of hiccups, in general, resolves itself without intervention, although many home remedies are often used to attempt to shorten the duration.[2] Medical treatment is occasionally necessary in cases of chronic hiccups.

Contents

Causes

Phylogenetic hypothesis

Researchers 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.[3] 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).

Signs & symptoms

  • A single or a series of breathing diaphragm spasms, of variable spacing and duration.
  • A brief (less than one half second), unexpected, shoulder, abdomen, throat, or full body tremor.
  • Hiccups might be easily heard as a chirp, squeak, "hupp", or if properly controlled, a quick inhaling gasp, sigh, or sniff.
  • The victim might complain of brief but distracting or painful, frequent or occasional interruptions in normal breath, with sudden momentary pain of the throat, chest, or abdomen.
  • If the hiccups are properly controlled there is no discomfort except for the mild distraction of the occasional uncontrollable gasp.

Factors

Causes of persistent hiccups

  • Metabolic diseases
  • Diabetes
  • Kidney failure
  • Electrolyte imbalance
  • Deviated septum

Infections

  • Pneumonia
  • CLD

CNS disorders

  • Stroke
  • Multiple sclerosis
  • Tumors
  • Meningitis
  • Encephalitis
  • Traumatic brain injury

Nerve damage/irritation

  • Vagus and phrenic nerve involvement
  • Laryngitis
  • Cysts
  • Goiter
  • Gastroesophageal reflux

Treatment

Numerous medical remedies exist but no particular treatment is known to be especially effective.[5] Many drugs have been used, such as baclofen, chlorpromazine, metoclopramide, gabapentin, and various proton-pump inhibitors. Hiccups that are secondary to some other cause like gastroesophageal reflux disease or esophageal webs are dealt with by treating the underlying disorder. A simple treatment involves increasing the partial pressure of CO2 and inhibiting diaphragm activity by holding one’s breath or rebreathing into a paper bag. Vagus nerve stimulation can improve hiccups, done at home by irritating the pharynx through swallowing dry bread or crushed ice, or by applying traction to the tongue, or by stimulating the gag reflex. The phrenic nerve can be blocked temporarily with injection of 0.5% procaine, or permanently with bilateral phrenicotomy or other forms of surgical destruction. Even this rather drastic treatment does not cure some cases, however.

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. Compare this ancient recommendation with the vagal nerve stimulation techniques mentioned previously.

An anecdotal medical approach is to install lidocaine liniment 3% or gel 2% in the external ear. Somehow this creates 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 lidocaine effect expires after about two hours.[6]

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.[7]

Hiccups are treated medically only in severe and persistent (termed "intractable") cases, such as in the case of Jennifer Mee, a 19-year-old girl who, in 2007, hiccuped continuously for five weeks.[8] 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. Effective treatment with sedatives often requires a dose that renders the person either unconscious or highly lethargic. Hence, medicating with sedatives is only appropriate short-term, as the affected individual cannot continue with normal life activities while under their effect.

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.[citation needed] The carbonation promotes quicker absorption. Carbonated beverages, including beer, by themselves may provoke hiccups in some people.[citation needed]

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.[9]

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."[10]

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.[11]

In 2007, Florida teenager Jennifer Mee gained media fame for hiccuping around 50 times per minute for more than five weeks.[12] 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.[13] Known as "Hiccup Girl", she was arrested after a fatal robbery and accused of murder in October 2010; her attorney suggests that Tourette Syndrome may be used to defend her case.[14]

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.[15]

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.[citation needed]

See also

References

  1. ^ a b Wilkes, Garry (2 August 2007). "Hiccups". eMedicine. Medscape. http://emedicine.medscape.com/article/775746-overview. Retrieved 2009-04-22. 
  2. ^ "Hiccups". Home Remedies. http://www.home-remedies-for-you.com/remedy/Hiccups.html. Retrieved 5 November 2011. 
  3. ^ Straus, C.; Vasilakos, K; Wilson, RJ; Oshima, T; Zelter, M; Derenne, JP; Similowski, T; Whitelaw, WA (February 2003). "A phylogenetic hypothesis for the origin of hiccough". BioEssays 25 (2): 182–188. doi:10.1002/bies.10224. PMID 12539245. 10.1002/bies.10224. http://www3.interscience.wiley.com/cgi-bin/abstract/102526391/ABSTRACT?CRETRY=1&SRETRY=0=Abstract. 
  4. ^ "Hiccups Happen!". University of Maryland Medical Center (Winter 2009). http://www.umm.edu/pediatrics/pdf/newsletter_win09.pdf. Retrieved 2011-04-07. 
  5. ^ Porter, Robert S., ed (2011). "Hiccups". The Merck Manual Online. Merck Sharp & Dohme. http://www.merckmanuals.com/professional/gastrointestinal_disorders/approach_to_the_patient_with_upper_gi_complaints/hiccups.html. 
  6. ^ "Miracle hiccough cure gets the attention it deserves". BMJ. 2006-10-07. http://www.bmj.com/content/333/7580/1222.3.extract. 
  7. ^ Engleman EG, Lankton J, Lankton B (December 1971). "Granulated sugar as treatment for hiccups in conscious patients". N. Engl. J. Med. 285 (26): 1489. doi:10.1056/NEJM197112232852622. PMID 5122907. 
    Boswell, Wendy (2007-03-25). "MacGyver Tip: Cure hiccups with sugar". The People's Pharmacy (Lifehacker). http://lifehacker.com/246873/macgyver-tip-cure-hiccups-with-sugar. Retrieved 2009-11-30. 
  8. ^ "Teen's hiccups stop after five weeks". ABC News Online. 2007-03-02. http://www.abc.net.au/news/newsitems/200703/s1861793.htm. 
  9. ^ Iwasaki, N; et al. (May 2007). "Hiccup treated by administration of intranasal vinegar". No to Hattatsu 39 (3): 202–5. PMID 17515134. 
  10. ^ Schaffer, Amanda (2006-01-10). "A Horrific Case of Hiccups, a Novel Treatment". New York Times. http://www.nytimes.com/2006/01/10/health/10hicc.html. Retrieved 2008-04-24. 
  11. ^ "Survivor of 68-Year Hiccup Spell Dies" (Sunrise Edition: 2.B. ed.). Omaha World-Herald. 5 May 1991. 
  12. ^ "Florida girl hiccuping again after returning to school". msnbc.msn.com. March 16, 2007. http://www.msnbc.msn.com/id/17643118. 
  13. ^ "Hiccup Girl: "I have Tourette's"". WTSP-TV, tampabays10.com. January 10, 2008. http://www.tampabays10.com/news/local/article.aspx?storyid=71545. 
  14. ^ ""Hiccup Girl" Jennifer Mee May Use Tourette's Defense, Says Lawyer". CBS News. October 27, 2010. http://www.cbsnews.com/8301-504083_162-20020853-504083.html. 
  15. ^ Symons, Jane (May 8, 2008). "So does holding your breath REALLY banish hiccups?". London: The Sun. http://www.thesun.co.uk/sol/homepage/woman/health/article1137753.ece. 

Further reading

  • Shubin, Neil (February 2008). "Fish Out of Water". Natural History: 26–31.  – hiccup related to reflex in fish and amphibians.

External links


Wikimedia Foundation. 2010.

Look at other dictionaries:

  • hiccup — (also hiccough (pronounced same)) ► NOUN 1) an involuntary spasm of the diaphragm and respiratory organs, with a sudden closure of the glottis and a characteristic gulping sound. 2) a minor difficulty or setback. ► VERB (hiccuped, hiccuping) ▪… …   English terms dictionary

  • hiccup — [hik′up΄, hik′əp] n. [altered < Early ModE hikop, hickock, hicket, of echoic orig. (as also in MDu huckup): var. sp. from assoc. with COUGH] 1. a sudden, involuntary contraction of the diaphragm when it begins to allow air into the lungs only… …   English World dictionary

  • hiccup — has inflected forms hiccuped, hiccuping. The spelling hiccough, formed by false association with cough, has nothing to recommend it …   Modern English usage

  • hiccup — I = hiccough hiccup UK [ˈhɪkʌp] / US [ˈhɪˌkʌp] or hiccough UK / US noun [countable] Word forms hiccup : singular hiccup plural hiccups Word forms hiccough : singular hiccough plural hiccoughs 1) a short repeated sound that you make in your throat …   English dictionary

  • Hiccup — A hiccup is an extraordinary type of respiratory movement involving a sudden inspiration (intake of air) due to an involuntary contraction of the diaphragm accompanied by closure of the glottis (the vocal apparatus of the larynx). The abrupt… …   Medical dictionary

  • hiccup — [[t]hɪ̱kʌp[/t]] hiccups, hiccuping, hiccupping (present participle), hiccuped, hiccupped (past tense & past participle) also hiccough 1) N COUNT: usu with supp, oft n N, N in n You can refer to a small problem or difficulty as a hiccup,… …   English dictionary

  • hiccup — (also hiccough) noun 1 sound made in the throat ADJECTIVE ▪ small ▪ loud VERB + HICCUP ▪ give, let out ▪ She gave a l …   Collocations dictionary

  • hiccup — {{11}}hiccup (n.) 1570s, hickop, earlier hicket, hyckock, a word meant to imitate the sound produced by the convulsion of the diaphragm [Abram Smythe Farmer, Folk Etymology, London, 1882]. Cf. Fr. hoquet, Dan. hikke, etc. Modern spelling first… …   Etymology dictionary

  • hiccup — /hik up, euhp/, n., v., hiccuped or hiccupped, hiccuping or hiccupping. n. 1. a quick, involuntary inhalation that follows a spasm of the diaphragm and is suddenly checked by closure of the glottis, producing a short, relatively sharp sound. 2.… …   Universalium

  • Hiccup — A slang term for a short term disruption within a longer term plan, goal, or trend. A hiccup can be used to describe the business actions of a particular company, a stock price downturn, or the stock market as a whole. Generally, a hiccup is not… …   Investment dictionary


Share the article and excerpts

Direct link
Do a right-click on the link above
and select “Copy Link”

We are using cookies for the best presentation of our site. Continuing to use this site, you agree with this.