Though usually a benign and self-limited annoyance, hiccups may be persistent and a sign of serious underlying illness. In patients on mechanical ventilation, hiccups can trigger a full respiratory cycle and result in respiratory alkalosis.
Causes of benign, self-limited hiccups include gastric distention (carbonated beverages, air swallowing, overeating), sudden temperature changes (hot then cold liquids, hot then cold shower), alcohol ingestion, and states of heightened emotion (excitement, stress, laughing). There are over 100 causes of recurrent or persistent hiccups, grouped into the following categories:
Central nervous system: Neoplasms, infections, cerebrovascular accident, trauma.
Metabolic: Uremia, hypocapnia (hyperventilation).
Irritation of the vagus or phrenic nerve: (1) Head, neck: Foreign body in ear, goiter, neoplasms. (2) Thorax: Pneumonia, empyema, neoplasms, myocardial infarction, pericarditis, aneurysm, esophageal obstruction, reflux esophagitis. (3) Abdomen: Subphrenic abscess, hepatomegaly, hepatitis, cholecystitis, gastric distention, gastric neoplasm, pancreatitis, or pancreatic malignancy.
Surgical: General anesthesia, postoperative.
Psychogenic and idiopathic.
Clinical Findings
Evaluation of the patient with persistent hiccups should include a detailed neurologic examination, serum creatinine, liver chemistry tests, and a chest radiograph. When the cause remains unclear, CT of the head
The American Academy of Ophthalmology and Otolaryngology was established in 1896, one of the earliest specialty organizations with a national scope. American board certification examination and recognition followed in 1924. The American Board of Otolaryngology-Head and Neck Surgery (AAO-HNS) is the second oldest of the 24 member boards of the American Board of Medical Specialties (ABMS). The specialty originally included the treatment of eye conditions and was commonly identified as EENT (eyes, ears, nose, and throat). However, as a result of the explosion of medical knowledge, ophthalmology split from otolaryngology many years ago. The American Academy of Otolaryngology (AAO) and the American Board of Otolaryngology (ABO) adopted a more anglicized qualification when the name was changed to "otolaryngology-head and neck surgery." Calling an otolaryngologist an "ENT" is no more appropriate than calling a cardiologist a "heart" or an oncologist a "cancer." (We'll leave the description of a colon and rectal surgeon to your imagination!)
|
