title: Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach.
abstract: BACKGROUND
  Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations.
  
  
  METHODS
  This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%).
  
  
  RESULTS
  A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders -mainly gastroesophageal reflux- were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died.
  
  
  CONCLUSIONS
  Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España. Electronic address: jgarciacall@hotmail.com.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: García Callejo
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Jaume
authors.initials: J
authors.lastname: Redondo Martínez
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Tomás
authors.initials: T
authors.lastname: Pérez Carbonell
authors.affiliation: Servicio de Otorrinolaringología, Hospital General de Requena, Requena, Valencia, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Monzó Gandía
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: M Paz
authors.initials: MP
authors.lastname: Martínez Beneyto
authors.affiliation: Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Inés
authors.initials: I
authors.lastname: Rincón Piedrahita
mesh_terms: D000328:Adult; D000368:Aged; D002746:Chlorpromazine / Q000627:therapeutic use; D002908:Chronic Disease; D003131:Combined Modality Therapy; D019468:Disease Management; D004599:Electric Stimulation Therapy; D004935:Esophageal Diseases / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006606:Hiccup / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D010036:Otolaryngology / Q000379:methods; D010791:Phrenic Nerve; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D008787:Metoclopramide; D002746:Chlorpromazine
keywords: Diagnostic; Diagnóstico; Etiology; Etiología; Hiccup; Hipo; Therapy; Tratamiento