hiccup

Definition

Hiccups are the result of an involuntary, spasmodic contraction of the diaphragm followed by the closing of the throat.

Description

Hiccups are one of the most common, but thankfully mildest, disorders to which humans are prey. Virtually everyone experiences them at some point, but they rarely last long or require a doctor's care. Occasionally, a bout of hiccups will last longer than two days, earning it the name "persistent hiccups." Very few people will experience intractable hiccups, in which hiccups last longer than one month.

A hiccup involves the coordinated action of the diaphragm and the muscles that close off the windpipe (trachea). The diaphragm is a dome-shaped muscle separating the chest and abdomen, normally responsible for expanding the chest cavity for inhalation. Sensation from the diaphragm travels to the spinal cord through the phrenic nerve and the vagus nerve, which pass through the chest cavity and the neck. Within the spinal cord, nerve fibers from the brain monitor sensory information and adjust the outgoing messages that control contraction. These messages travel along the phrenic nerve.

Irritation of any of the nerves involved in this loop can cause the diaphragm to undergo involuntary contraction, or spasm, pulling air into the lungs. When this occurs, it triggers a reflex in the throat muscles. Less than a tenth of a second afterward, the trachea is closed off, making the characteristic "hic" sound.

— Richard Robinson

1. 1. A spasm of the diaphragm resulting in a rapid, involuntary inhalation that is stopped by the sudden closure of the glottis and accompanied by a sharp, distinctive sound.
   2. hiccups also hiccoughs An attack of these spasms. Often used with the.
2. The sound made by such a spasm or a sound resembling it: "the urgent hiccup of a police siren" (John Updike).

1. To make a hiccup or a sound like a hiccup.
2. To have an attack of hiccups.

[Imitative.]

For more information on hiccup, visit Britannica.com.

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 indicative of a larger trend, but is considered an aberration.

Investopedia Says:
One of the biggest challenges for investors is determining what is merely a hiccup, and what is a harbinger of things to come. If a company misses sales estimates one quarter, this may be an isolated event, or it may be the first of several misses highlighting a core problem in the business model.

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Hiccough or hiccupWe are all familiar with the common occurrence of hiccup or hiccough. It consists of a series of forceful but abruptly blocked intakes of breath. Each abrupt blocking of inspiration gives rise to a characteristic sound. The condition is often triggered by gastric distension or alcohol intake, normally lasts for no longer than a few hours, and is either self-terminating or responds to simple folk remedies. However, on rare occasions hiccups can be present continuously for more than 24 hours or prolonged bouts may recur daily. Such cases of chronic hiccups may reflect a great variety of underlying disease processes. Chronic hiccups have been reported in association with disorders and lesions of systems as diverse as the gastrointestinal, hepatic, renal/urinary, and both the central and peripheral nervous systems. In addition, chronic hiccups can occur following the administration of certain drugs and as an accompaniment to psychiatric illness. The direct danger of severe hiccups, continuously present over a long period of time, is simply one of physical exhaustion, quite apart from any hazards relating to underlying disease or drugs.

A hiccup is produced by a sudden, forceful contraction of the diaphragm. This causes a rapid inspiration but the inflow of air through the larynx into the lungs is blocked by an almost immediate closure of the glottis, meaning that the vocal cords come together. This process has no known physiological function; in fact there is remarkably little information on the biology of hiccups. They can occur in a wide variety of circumstances, from those associated in the fetus with normal activity to those accompanying terminal disease. Some workers have suggested that there is a hiccup centre in the brain and experimental work in anaesthetized animals has located a region in the medulla which, when stimulated electrically, produces a powerful inspiration with sudden glottic closure. This can also be produced by mechanical stimulation of the back wall of the upper pharynx.

The general assumption is consequently that hiccups are due to activation of a reflex because of an adequate but abnormal or pathological sensory input, or because the threshold for the reflex is substantially lowered by excitation within the brain, or because an existing inhibition of the reflex is removed. It is difficult to envisage the circumstances in which such a reflex would have any utility. An alternative suggestion is that the condition is not a reflex but a myoclonus, which is defined in this context as a sudden, brief, involuntary movement, arising from abnormal spontaneous activity within the central nervous system, comparable to that occurring in epilepsy. Chronic hiccups have been associated with brain lesions in diverse areas including the temporal lobe, the thalamus, and understandably, the medulla.

Simple hiccups may respond to a variety of folk remedies, e.g. a sudden fright, breath-holding, or drinking a large glass of water without taking a breath. Most of such remedies have the common feature in that they interrupt breathing and so could increase the level of carbon dioxide circulating in the blood. An increased arterial carbon dioxide level in turn increases the drive to the respiratory system and the assumption is that this enables the medullary respiratory centre to suppress interruptions (hiccups) to its ongoing rhythmic activity. However, in the rare cases of chronic hiccups, attention has to be directed to diagnosis and treatment of the underlying disease state, to remove the triggering factors. If no underlying disease can be found, or if a drug is inducing the hiccups but that drug is essential to some other treatment, the condition may have to be treated symptomatically using an agent that will simply suppress it.

Despite many well-conducted investigations, the current state of knowledge of hiccups is still unsatisfactory.

— Allan Thexton

An involuntary spasmodic contraction of the diaphragm that causes a beginning inspiration that is suddenly checked by closure of the glottis, thus producing a characteristic sound.

Definition

Hiccups are the result of an involuntary, spasmodic contraction of the diaphragm followed by the closing of the throat.

Description

Virtually everyone experiences hiccups, but they rarely last long or require a doctor's care. Occasionally, a bout of hiccups will last longer than two days, earning it the name "persistent hiccups." Very few people will experience intractable hiccups, in which hiccups last longer than one month.

A hiccup involves the coordinated action of the diaphragm and the muscles that close off the windpipe (trachea). The diaphragm is a dome-shaped muscle separating the chest and abdomen. It is normally responsible for expanding the chest cavity for inhalation. Sensation from the diaphragm travels to the spinal cord through the phrenic nerve and the vagus nerve, which pass through the chest cavity and the neck. Within the spinal cord, nerve fibers from the brain monitor sensory information and adjust the outgoing messages that control contraction. These messages travel along the phrenic nerve.

Irritation of any of the nerves involved in this loop can cause the diaphragm to undergo an involuntary contraction, or spasm, pulling air into the lungs. When this spasm occurs, it triggers a reflex in the throat muscles. Less than a tenth of a second afterward, the trachea is closed off, making the characteristic "hic" sound.

Causes & Symptoms

Hiccups can be caused by disorders of the central nervous system, by injury or irritation to the phrenic and vagus nerves, and by toxic or metabolic disorders affecting the central or peripheral nervous systems. They may be of unknown cause or may be a symptom of psychological stress. Hiccups often occur after drinking carbonated beverages or alcohol. They may also follow overeating or rapid temperature changes. Persistent or intractable hiccups may be caused by any condition that irritates or damages the relevant nerves, including:

• overstretching of the neck
• laryngitis
• heartburn (gastroesophageal reflux)
• irritation of the eardrum (which is innervated by the vagus nerve)
• general anesthesia
• surgery
• bloating
• tumor
• infection
• diabetes

Diagnosis

Hiccups are diagnosed by observation and by hearing the characteristic sound. Diagnosing the cause of intractable hiccups may require imaging studies, blood tests, pH monitoring in the esophagus, and other tests.

Treatment

Most cases of hiccups will disappear on their own. Home remedies, which interrupt or override the spasmodic nerve circuitry, are often effective. Such remedies include:

• Holding one's breath for as long as possible.
• Breathing into a paper bag.
• Swallowing a spoonful of sugar or peanut butter.
• Bending forward from the waist and drinking water from the wrong side of a glass.

Acupressure techniques can also be helpful in eliminating hiccups. Acupressure is a Chinese medicine treatment that involves placing pressure on different points of the body, called acupoints. It is based on the premise that good health is based on a harmony of energy flow, or qi, throughout the body. By placing pressure on acupoints, qi is balanced and harmony—and health—is restored to the patient.

To treat hiccups through acupressure, rest the heels of the palms on both cheekbones while placing hands over the eyes. Massage the temples by pulling the thumbs in towards the palm. After massaging, remove the hands from the eyes and lightly press the tip of the nose with a fingertip.

Allopathic Treatment

Treating any underlying disorder will usually cure the associated hiccups. Chlorpromazine (Thorazine) relieves intractable hiccups in 80% of cases. Metoclopramide (Reglan), carbamazepam, valproic acid (Depakene), and phenobarbital are also used. As a last resort, surgery to block the phrenic nerve may be performed, although it may lead to significant impairment of respiration.

Expected Results

Most cases of hiccups last no longer than several hours, with or without treatment.

Prevention

Some cases of hiccups can be avoided by drinking in moderation, avoiding very hot or very cold food, and avoiding cold showers. When carbonated beverages are drunk through a straw, more gas is delivered to the stomach than when they are sipped from a container; therefore, avoid using straws.

Resources

Book

Hurst, J. Willis, ed. Medicine for the Practicing Physician. 4th ed. Stamford, Conn.: Appleton & Lange, 1996.

[Article by: Paula Ford-Martin]

Four remedies for hiccups are generally quoted. One is to breathe into a paper bag (in and out, as long as it takes), another is to hold one's breath. The third is to drink a cup of water backwards, that is out of the opposite side of the cup than normal, which can be done by bending over and tilting the cup slightly away from you (with your chin inside the cup). The fourth is to be startled out of them by someone making you jump. Earlier remedies tend to be more complex. ‘Take a cup of water, and say: Hiccups, Jiccups, Rise up Jacob, Seven gullups in the cup, Cure Hiccups’ (Jones-Baker, 1977: 99). A correspondent in N&Q (5s:3 (1865), 465) writes that you must cross the front of the left shoe with the forefinger of the right hand, while you repeat the Lord's Prayer backwards. In the 1820s, Edward Moor recommended holding the breath and saying, three times, ‘Hiccup—sniccup—look up—right up—three drops in a cup—is good for the hiccup’ (Moor, 1823: 167); long before that, in 1584, Reginald Scot commented, ‘Some will hold fast their left thombe in their right hand when they hickot; or else will hold their chinne with their right hand whiles a gospell is soong.’

Bibliography
The full bibliography list is available here.

• Opie and Tatem, 1989: 198-9

Singultus

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

A hiccup or hiccough (pronounced /ˈhɪkʌp/ HICK-up) is an esophageal contraction of the diaphragm that repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the epiglottis 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 claim to shorten the duration, and medical treatment is occasionally necessary in cases of chronic hiccups.

Contents 1 Causes 1.1 Phylogenetic hypothesis 2 Treatment 2.1 Medical treatment 2.2 Home remedies 3 Long-term cases 4 See also 5 References 6 Further reading 7 External links

Causes

	Hiccup sound The sound of a human hiccup
Problems listening to this file? See media help.

Hiccups are caused by many central and peripheral nervous system disorders, all from injury or irritation to the phrenic and vagus nerves, as well as toxic or metabolic disorders affecting the aforementioned systems. Hiccups often occur after drinking carbonated beverages or alcohol. Prolonged laughter is also known to cause hiccups. Persistent or intractable hiccups may be caused by any condition which irritates or damages the relevant nerves. Chemotherapy—which can include a huge amount of different drugs—has been implicated in hiccups (some data states 30 percent of patients),^{[citation needed]} while other studies have not proven such a relationship. Many times chemotherapy is applied to tumors sitting at places that are by themselves prone to cause hiccups, if irritated.^[2][3]

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 frogs gulp air and water via a rather simple motor reflex akin to mammalian hiccuping.^[4] 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 to form; thus according to recapitulation theory 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 would 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.^[5]

Treatment

Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them.^{[citation needed]} However, there are a number of anecdotal treatments for casual cases of hiccups. Some of the more common home remedies include giving the afflicted a fright or shock, eating peanut butter, taking a teaspoon of vinegar, drinking water (sometimes in an unorthodox manner), holding one's breath and altering one's breathing patterns. 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.^[6]

Medical treatment

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.^[7] 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.

Digital rectal massage has been recommended as a remedy that causes immediate cessation of hiccups and which should be tried before resorting to drugs.^[8]

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 have though by themselves a tendency to provoke hiccup in some persons.

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. In 2005, the agency endorsed the use of the stimulator as a treatment of last resort for people with severe depression".^[10]

Home remedies

While numerous home remedies are offered, they mostly fall into three broad categories: purely psychosomatic cures centered on relaxation and distraction, cures involving swallowing and eating (with the general rationale that this would remove irritants or reset mechanisms in the affected region).

Long-term cases

American man 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, a teenager from Washington State in the United States named Cheyenne Motland hiccuped around 50 times a minute for more than five weeks.^[12] After her hiccups returned, her neurologist suggested that she may have Tourette syndrome, and the hiccups may be a "tic" caused by Tourette's.^[13]

Christopher Sands from the UK had hiccups for a period of almost three years which was eventually discovered to be due to a tumor located on the part of the brain that controls vascular activities, once 2/3 of the tumor was removed the hiccups appeared to settle and Sands no longer suffers from his condition.^[14]

See also

• Getting the wind knocked out of you
• Sneeze
• Cough

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, Information about Hiccups". Faqs.org. http://www.faqs.org/health/topics/2/Hiccups.html. Retrieved 2010-01-12. 
3. ^ "Hiccups: Adverse Reaction to Chemo". Annieappleseedproject.org. 2002-05-15. http://www.annieappleseedproject.org/hicasadreact.html. Retrieved 2010-01-12. 
4. ^ 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. 10.1002/bies.10224. PMID 12539245. http://www3.interscience.wiley.com/cgi-bin/abstract/102526391/ABSTRACT?CRETRY=1&SRETRY=0=Abstract. Retrieved 2007-07-20. 
5. ^ Kahrilas, P.J.; Shi, G (November 1, 1997). "Why do we hiccup?". Gut 41 (5): 712–713. doi:10.1136/gut.41.5.712 (inactive 2010-01-09). PMID 9414986. PMC 1891574. http://gut.bmj.com/cgi/content/extract/41/5/712. Retrieved 2007-07-20. 
6. ^ 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. 
7. ^ "Teen's hiccups stop after five weeks". ABC News Online. 2007-03-02. http://www.abc.net.au/news/newsitems/200703/s1861793.htm. 
8. ^ Odeh, M; Bassan, H; Oliven, A (February 1990). "Termination of intractable hiccups with digital rectal massage". J Intern Med 227 (2): 145–6. doi:10.1111/j.1365-2796.1990.tb00134.x. PMID 2299306. http://www.ncbi.nlm.nih.gov/pubmed/2299306?dopt=Abstract. Retrieved 2008-04-24. 
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. 
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. ^ "So does holding your breath REALLY banish hiccups?". The Sun. May 8, 2008. http://www.thesun.co.uk/sol/homepage/woman/health/article1137753.ece. 

Further reading

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

External links

Look up hiccup in Wiktionary, the free dictionary.

• BBC News: Why we hiccup
• Retrospective analysis of hiccups in patients at a community hospital from 1995-2000

v • d • e Symptoms and signs: respiratory system (R04-R07, 786) Hemorrhage Epistaxis · Hemoptysis Abnormalities of breathing Respiratory sounds: Stridor · Wheeze · Rales · Rhonchi · Hamman's sign Dyspnea · Hyperventilation/Hypoventilation · Hyperpnea/Tachypnea/Bradypnea · Orthopnea/Platypnea Biot's respiration · Cheyne-Stokes respiration · Kussmaul breathing Hiccup · Mouth breathing/Snoring · Breath-holding Other Asphyxia · Cough · Pleurisy · Sputum Respiratory arrest · Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy · Egophony · Bronchophony Pleural friction rub Fremitus Chest, general Chest pain respiratory system navs: anat nose, larynx/lower+thoracic cavity/physio/dev, noncongen/congen/tumors, symptoms+signs/eponymous, proc

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Dansk (Danish)
n. - hikke
v. intr. - hikke

Nederlands (Dutch)
hikken, de hik hebben, met horten en stoten uitbrengen, de hik

Français (French)
n. - (lit) hoquet, (fig) anicroche
v. intr. - hoqueter

Deutsch (German)
v. - den Schluckauf haben
n. - Schluckauf, kleine Panne

Ελληνική (Greek)
v. - έχω λόξιγκα
n. - λόξιγκας

Italiano (Italian)
singhiozzo, avere il singhiozzo

Português (Portuguese)
v. - soluçar
n. - soluço (m)

Русский (Russian)
икать

Español (Spanish)
n. - hipo
v. intr. - hipar, tener hipo

Svenska (Swedish)
v. - hicka
n. - hicka, litet problem

中文（简体）(Chinese (Simplified))
打嗝, 发出类似打嗝的声音

中文（繁體）(Chinese (Traditional))
n. - 打嗝
v. intr. - 打嗝, 發出類似打嗝的聲音

한국어 (Korean)
n. - 딸꾹질, (주식 시세의) 일시적 하락, 좀 거북한 문제
v. intr. - 딸꾹질 하다, 딸꾹질하면서 이야기하다

日本語 (Japanese)
n. - しゃっくり
v. - しゃっくりをする

العربيه (Arabic)
‏(فعل) يفوق أو يحوزق يصاب بالفواق أو الحازوقه (الاسم) فواق أو حازوقه‏

עברית (Hebrew)
n. - ‮שיהוק‬
v. intr. - ‮שיהק‬

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