Singultus

2 scenarios:

  • A stroke/tumor/meningitis patient with new hiccup – is it a sign of impending danger (such as yawning)? yes – ami! otherwise no! It mainly appears with medullary strokes and temporal lesions.
  • A patient referred for permanent hiccup since 2 years, already evaluated by ENT and GI specialists.

Workup:

  • History (drugs, GI problems, etc.)
  • Physical examination (oral, external ear canal!)
  • EGD
  • Ultrasound abdomen
  • Chest CT including upper abdomen
  • Cervical US (thyroid)
  • Cranial MRI

As for treatment, there are some interesting household remedies (cold water, Valsalva, etc., mainly aiming for a vagal stimulation) and other mechanical ways, such as

  • catheter insertion into the pharynx, larynx, esophagus
  • external ear stimulation
  • bulbar pressure

Next, drugs: MCP/Haloperidol, Baclofen, Gabapentin, Propofol, Ketamine (these are my favorites). Important: try them with high doses (at least the first four) then taper the dose rapidly to the effective least dose.

Finally, for chronic cases: Vagal stimulator.

Here is the best reference (in german):  Singultus. HNO 1999 – note that nothing much happened in singultus in the last years; quite surprising…

 

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