What is Singultus?

A condition characterized by repeated involuntary spasms of the diaphragm that are each accompanied by an abrupt closure of the vocal cords is known as singultus, or hiccups. Considered a common condition, singultus may occur over the short or long term and be instigated by a variety of factors. Most cases of singultus subside independently; however, if the condition persists, medical treatment may be necessary.

Triggers associated with the sudden onset of short-term singultus are diverse. Individuals who overeat, eat too quickly, or consume carbonated beverages may develop singultus. Excessive alcohol consumption or exposure to abrupt changes in temperature may also induce symptoms. In some cases, the physical strain associated with emotionally charged situations or stressful conditions may increase an individual’s chance of becoming symptomatic.

Episodes of hiccups, or hiccoughs as they are sometimes called, that last more than a day or two may be induced by physiological factors as opposed to those associated with behavior or environment. Prolonged episodes of hiccups may result from irritation or damage inflicted on the phrenic or vagus nerves, which are directly involved with proper diaphragm function. Digestive disorders, such as gastroesophageal reflux disease (GERD), and throat irritation may contribute to nerve irritation. Conditions that adversely affect the nervous system, such as encephalitis and meningitis, or systemic diseases, like diabetes, may also impair nerve function. Use of certain medications such as barbiturates, tranquilizers, and steroids may contribute to nerve damage.

Individuals who develop hiccoughs may initially experience a feeling of tightness in their throat, chest, or abdomen that lasts momentarily. As the diaphragm contracts, the individual’s vocal cords abruptly close causing him or her to make a squeak or hic sound, thus the common moniker for the condition. The number and intensity of hiccups experienced in a given period of time varies by individual. Medical attention should be sought for severe symptoms that impair one’s ability to breathe properly or for symptoms that last more than a couple of days.

Long-term episodes of hiccups may be indicative of an underlying medical condition. A variety of diagnostic tests may be administered to determine the cause for the prolonged hiccup episodes and may include imaging, laboratory, and endoscopic tests. Imaging tests may include the use of a chest X-ray, magnetic resonance imaging (MRI), or computerized tomography (CT) scan to check for damage to the phrenic or vagus nerves. Laboratory blood tests may be utilized to check for the presence of infection or disease. Endoscopic tests that employ a tiny camera, known as an endoscope, may be used to evaluate the condition of an individual’s windpipe or esophagus.

Short-term singultus episodes generally subside independently and require no medical attention. Treatments utilized for long-term episodes of the hiccups may include the use of medications and, for severe cases, surgical procedures. Those individuals whose hiccup episodes are induced by an underlying medical condition may find that their symptoms subside once the secondary condition is successfully treated.

Medications used to treat prolonged episodes of singultus may include muscle relaxants, anti-nausea drugs, and antipsychotics. Individuals with chronic singultus, who are exhibiting abdominal distention, may undergo the placement of a nasogastric (NG) tube that works to stimulate the throat and release the air that has accumulated in the stomach. Those who have been unresponsive to traditional treatment may find symptom relief through the use of nerve blocks or stimulation. In some cases, the phrenic nerve may be injected with an anesthetic medication that blocks impulses and prevents the spasms associated with symptom onset. Mild electrical stimulation delivered to the phrenic nerve by an implanted, battery-operated device may also be employed to control chronic hiccups.

Persistent hiccups may temporarily impair one’s ability to eat, drink, or speak. Individuals with this condition may also find it difficult to sleep. Those who have recently undergone a surgical procedure may experience some discomfort during a hiccough episode. Risk factors that may contribute to the development of this condition include anxiety, exposure to stressful or traumatic situations, certain surgical procedures, and the use of general anesthesia.