- 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.
- History (drugs, GI problems, etc.)
- Physical examination (oral, external ear canal!)
- 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…