Reading: Matching Features: Question 7

Persistent Hiccups: Four Ways Doctors Try to Stop Them

Most bouts of hiccups end within minutes, but a small number of patients develop an episode lasting more than 48 hours, a condition doctors call persistent hiccups, or one lasting beyond a month, termed intractable hiccups. Left untreated, a prolonged episode can disturb sleep and eating, and in rare cases leave a patient exhausted and underweight. Clinicians have developed several approaches to interrupt the reflex, each suited to a different stage of severity.

The first line of treatment is usually a set of simple vagal manoeuvres (actions such as holding the breath, swallowing a spoonful of dry sugar, or gargling with ice-cold water) that stimulate the vagus nerve and can interrupt the reflex arc responsible for the spasm. These techniques require no prescription and can be attempted by the patient at home; case reviews suggest they resolve roughly one in three episodes that have lasted under a week, with no reported side effects.

When vagal manoeuvres fail, doctors often turn to a muscle-relaxant medication taken by mouth for one to two weeks, most commonly a drug that dampens the nerve signalling responsible for the diaphragm's spasms. It remains the most widely used treatment for hiccups persisting beyond 48 hours, but because it acts on the central nervous system its most common side effect is drowsiness, and patients are advised not to drive during the course.

For cases that do not respond to medication, an anaesthesiologist can perform a phrenic nerve block, injecting a local anaesthetic close to the nerve that controls the diaphragm under ultrasound or X-ray guidance. The hiccups stop only for as long as the injected anaesthetic keeps the nerve numbed, typically one to three weeks, giving the diaphragm an extended rest; the procedure is generally reserved for episodes that have already resisted simpler treatment.

In the rare cases where hiccups continue for months or years despite every other measure, surgeons can implant a diaphragmatic pacing device, a battery-powered unit similar in principle to a cardiac pacemaker, which delivers regular electrical pulses to override the erratic nerve signal. Because it requires surgery and ongoing device maintenance, it is used only once every less invasive option, including a nerve block, has already been tried and failed.

Acupuncture has also been tried for stubborn hiccups, and individual clinicians report occasional success, but the handful of published cases are too small and too inconsistent for researchers to draw any general conclusion about how often it works or for whom, and it does not currently appear in standard treatment guidelines.

List of Treatments A vagal manoeuvres B muscle-relaxant medication C a phrenic nerve block D a diaphragmatic pacing device E acupuncture

Match each statement with the correct option, A–E. NB You may use any option more than once.

1 Can be attempted by a patient at home without a doctor's involvement. 2 Its effect on the hiccups lasts only as long as the anaesthetic keeps the relevant nerve numbed. 3 Is only used once every less invasive treatment, including an injected nerve block, has already failed. 4 Is usually prescribed only after simple physical techniques have not stopped the hiccups. 5 Commonly makes patients feel drowsy, so they are advised not to drive while taking it. 6 Requires a surgically implanted device that functions on a similar principle to a device used for heart problems. 7 Is carried out by a specialist using imaging to guide an injection near a specific nerve. 8 Resolves roughly one in three episodes that have lasted less than a week.