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Hiccup

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Hiccup
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A hiccup or hiccough (normally pronounced "HICK-up" /ˈhɪkʌp/, though hiccough is an archaic and now disused spelling), is a spasmodic contraction of the diaphragm that typically repeats several times per minute. In humans, the abrupt rush of air into the lungs causes the epiglottis to close, creating the "hic" listenⓘ noise. In medicine, it is known as synchronous diaphramatic flutter (SDF), or singultus. The term "hiccup" is also used to describe a small and unrepeated aberration in an otherwise consistent pattern.

A bout of hiccups generally resolves itself without intervention, although many home remedies claim to shorten the duration, and medication is occasionally necessary.

Causes

While many cases develop spontaneously, hiccups are known to be triggered by specific events, such as eating too quickly, being hungry for long, taking a cold drink while eating a hot meal, belching, eating very hot or spicy food, laughing vigorously or coughing, drinking alcoholic beverages in excess, crying out loud (sobbing causes air to enter the stomach), some smoking situations where abnormal inhalation can occur (in tobacco or other smoke like cannabis, perhaps triggered by precursors to coughing), electrolyte imbalance, talking too long, clearing the throat, or from lack of vitamins. Hiccups may be caused by pressure to the phrenic nerve by other anatomical structures, or having the sensation that there is food in the esophagus, rarely by tumors and certain kidney disease. The American Cancer Society reports that 30% of chemotherapy patients suffer singultus as a side effect of treatment.

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.[1] 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 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.[2]

Amniotic/atmospheric hypothesis

Ultrasound scans have also shown that babies in-utero experience hiccups. The amniotic/atmospheric hypothesis suggests that hiccups are a muscle exercise for the respiratory system prior to birth, or that they prevent amniotic fluid from entering the lungs.[3] The amniotic/atmospheric hypothesis holds that there are two distinct systems in the brain for controlling respiration: one that is used when the fetus is respiring amniotic fluid during its time in the womb, and another that only comes into use following birth, used for breathing air. Since amniotic fluid is much more viscous than air, a much greater effort is required from the diaphragm to inhale it. If this amniotic breathing system becomes dominant for any reason during life outside the womb, the result will be a momentary, very forceful effort at inhalation. The body senses that things are not correct, and since so much force is actually dangerous to the lungs and other organs, the system is immediately preempted and switched back to the atmospheric system. However, this preemptive control gradually relaxes, making the phenomenon cyclic as long as there is underlying activation of the amniotic respiration system: as the preemptive control falls below the threshold, the amniotic routine resumes control, only to be preempted again, and this cycle continues until the underlying conditions leading to the amniotic breathing activation revert to their normal state – at which point the hiccups stop. This theory is supported by the finding that hiccups are more common in premature newborns, as in these cases the atmospheric respiration system is less prepared to take precedence over the amniotic respiration system.

Treatment

Ordinary hiccups are cured easily without medical intervention; in most cases they can be stopped simply by forgetting about them. However, there are a number of anecdotally prescribed treatments for casual cases of hiccups (see Home Remedies below). Some of the more common home remedies include: scaring the afflicted, drinking water (sometimes in an unorthodox manner), and altering one's breathing.

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.[4] 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.

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.

The administration of intranasal vinegar is thought to be safe and handy method to stimulate dorsal wall of nasopharynx, where the pharyngeal branch of the glossopharyngeal nerve (afferent of the hiccup reflex arc) is distributed.[5]

Dr. Bryan R. Payne, a neurosurgeon at the Louisiana State University Health Sciences Center in New Orleans, has had some success with an experimental new 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."[6]

Home remedies

The following are some commonly suggested home remedies. While numerous remedies are offered, they mostly fall into a few broad categories. These categories include purely psychosomatic cures centered around relaxation and distraction, cures involving swallowing and eating (with the rationale generally that this would remove irritants or reset mechanisms in the affected region), and cures involving controlled/altered breathing.

The first two categories may prove effective for many short lived and minor cases of hiccups. For instance, with an assistant applying pressure to one's ears, drinking any quantity of liquid whilst holding one's nose is a common home remedy for hiccups. However, those suffering from an intractable case may become desperate sorting through various ineffective home remedies. Many of the cures centered around controlled breathing (i.e. holding breath) are often ineffective for prolonged hiccups crises, but do have a significant efficacy for the most casual, short lasting cases. For these scenarios, the underlying rationale could be the displacement of an irritated nerve through prolonged diaphragmatic expansion.

However, one respiratory remedy has a fairly sound rationale underlying it. Breathing into a bag or small enclosed container (ensuring that it is completely sealed around the mouth and nose) induces a state of respiratory acidosis. The effect is caused by increasing the amount of inspired carbon dioxide, which then increases the level of carbon dioxide in the serum. These increased levels of CO2 lower the pH in the blood, hence creating a state of acidosis. This state of acidosis produces vasodilation and depression of the central nervous system. The effect allows for increased blood flow to the affected muscles, and suppression of the aberrant nervous impulses. Inducing a state of acidemia through hypoventilation is particularly effective in curing hiccups because the diaphragm rests directly against the pulmonary vasculature that is then flowing with especially low pH blood. This is a potentially dangerous action; and should only be done with another person present. As the serum CO2 level rises abruptly, the person will begin to feel lightheaded and within a few minutes will pass out. If done without a spotter, the person might either injure him or herself as he or she passes out, or pass out in such a way that the bag or container continues to prevent oxygen intake (see also asphyxia).

Another method is to simply run up and down a flight of stairs 3-4 times. This causes your breathing pattern to change which stops your hiccups. [7]

Additionally, another respiratory remedy appears to be one of the most effective in treating persistent hiccups. One breathes out all the air that he is able to in one long exhalation then breathes in all the air he feels he possibly can in one continuous inhalation. The person then attempts to breathe in even more air in a series of short powerful puffs, until his lungs cannot hold any more. The person remains in this state for as long as he feels a small gas bubble coming at the very base of the throat, ready to be burped. Although the success rate is not 100%, many people find this method consistently works. One scientific explanation for this method is that, by breathing an extreme load of air, the lungs tend to take more space in the chest, applying pressure on the surrounding content. The so-called gas bubble, which was located in an abnormal location potentially disturbing a nerve and causing the spasm, is then released.[citation needed]

Psychosomatic

  • Distraction from one's hiccup (e.g. being startled, asked a perplexing question, or counting in reverse from 100 down or reciting the alphabet in reverse.)[citation needed]
  • Concentration on one's hiccups - using sheer will to stop them[citation needed]
  • Pinch your ear lobe and breathe normally. Can turn into second-nature.[citation needed]

Respiratory

  • Cutting air off from the esophagus. One method is to tip one's head forward and downward as far as possible.[citation needed]
  • Isometric breathing, the process of breathing slowly and deeply in while thinking 'breathing out' and breathing slowly and fully out while thinking 'breathing in'[citation needed]
  • Holding one's breath while optionally squeezing one's stomach.[citation needed]
  • Breathing deeply through the nose, then exhaling slowly through the mouth. This is also a Lamaze technique.[citation needed]
  • Exhaling all the air from one's lungs and holding one's breath while swallowing water or saliva.[citation needed]
  • Blowing up a balloon[citation needed]
  • Inducing sneezing[citation needed]
  • Insert fingers in ears and hold breath for as long as possible[citation needed]
  • Attempting to burp[citation needed]
  • Exhaling all the air of one's lungs (or as much as possible, due to residual volume) and holding it as long as possible (theoretically stops the spasm on the diaphragm).[citation needed]

Other

  • Eating something very sweet, or tart (particularly lemon juice), or both.[8]
  • Make out with someone. The sucking action during deep kisses stops the hiccups.[citation needed]
  • Take a gulp of water or liquid, hold in mouth, insert fingers in ears and swallow while fingers are still in ears.[citation needed]
  • In babies, hiccups are usually immediately stopped by the suckling reflex, either by breastfeeding or simply by insertion of a finger, bottle teat or dummy into the baby's mouth.[citation needed]
  • Close your eyes and look up as far as possible.[citation needed]
  • Drinking a good amount of water[citation needed]
  • Chew a spoonful of peanut butter slowly, or put sugar on the tongue.[citation needed]
  • Mix sugar into a cup of water and drink slowly[citation needed]
  • Press tongue hard against roof of mouth.[citation needed]
  • Digital rectal massage[9]
  • Drinking water from the back of a glass
  • Get a bowl of water, fill it up, and stick your head in it. Breathe in deeply before you do this, and while in the bowl breathe out as SLOWLY as possible![citation needed]
  • Drink a glass of water through a paper towel.[citation needed]
  • Bend over, drink a glass of water upside down while standing on one foot with one finger of your dominant in the opposite ear.[citation needed]
  • Holding a spoon to your lips, slowly pour water over the spoon into your mouth and drink until hiccups subside.
  • Or, if you're drunk, just hurl![citation needed]

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.[10]

In January 2007, teenager Jennifer Mee from Florida in the United States hiccuped for five weeks, from January 23, 2007 until February 28, 2007.[11] After her hiccups returned, however, her neurologist suggested that she may actually be suffering from Tourette Syndrome.[12]

See also

References

  1. ^ Straus, C. (2003 Feb). "A phylogenetic hypothesis for the origin of hiccough". BioEssays. 25 (2): 182–188. 10.1002/bies.10224. Retrieved 2007-07-20. {{cite journal}}: Check date values in: |date= (help)
  2. ^ Kahrilas, P.J. (1997 Nov). "Why do we hiccup?". Gut. 41 (5): 712–713. Retrieved 2007-07-20. {{cite journal}}: Check date values in: |date= (help)
  3. ^ Randerson, James, Tadpoles take blame for human hiccups, New Scientist, Feb. 3, 2003
  4. ^ "Teen's hiccups stop after five weeks". ABC News Online. 2007-03-02.
  5. ^ Iwasaki, N (2007 May). "Hiccup treated by administration of intranasal vinegar". No To Hattatsu. 39 (3): 202–5. {{cite journal}}: |access-date= requires |url= (help); Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ Schaffer, Amanda (2006-01-10). "A Horrific Case of Hiccups, a Novel Treatment". New York Times. Retrieved 2008-04-24.
  7. ^ Christopher Siesky, Wadsworth City Schools
  8. ^ "Hiccups". Health911.com. Retrieved 2008-04-24.
  9. ^ Odeh, M; Bassan, H; Oliven, A (1990 February). "Termination of intractable hiccups with digital rectal massage". J Intern Med. 227 (2): 145–6. Retrieved 2008-04-24. {{cite journal}}: Check date values in: |date= (help)
  10. ^ "Survivor of 68-Year Hiccup Spell Dies. Omaha World - Herald, 05 May 1991, Sunrise Edition: 2.B.
  11. ^ "Florida girl hiccuping again after returning to school". msnbc.msn.com. March 16, 2007. {{cite news}}: Check date values in: |date= (help)
  12. ^ "Hiccup Girl: "I have Tourette's"". WTSP-TV, tampabays10.com. January 10, 2008. {{cite news}}: Check date values in: |date= (help)
  • "Fish Out of Water", Neil Shubin, Natural History, February 2008 issue, pages 26-31 - hiccup related to reflex in fish and amphibians.
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