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A Case Presentation and Etiologic Review

Lloyd M. Loft, MD; Robert F. Ward, MD

Arch Otolaryngol Head Neck Surg. 1992;118(10):1115-1119.

Abstract
• Hiccups (singultus) usually present as a common annoyance lasting for short periods. Rarely, they may be the harbinger of a serious disease. We present the case of a 19-year-old man in which intractable hiccups was the first and most prominent symptom of a serious underlying neurologic disorder. The patient had been examined by his pediatrician, and despite multiple medical regiments and physical maneuvers, his symptoms persisted. A thorough head and neck examination revealed a right-sided vocal cord paralysis. This finding prompted obtaining a magnetic resonance imaging scan, which demonstrated a type I Arnold-Chiari malformation associated with a large cervicothoracic syringomyelia. The patient was referred to the neurosurgical service and subsequently underwent a ventriculoperitoneal shunt placement. There was considerable initial improvement in his neurologic status and cessation of the hiccups. However, the symptoms recurred within 1 month. The case report as well as a brief review of the relevant pathophysiologic and etiologic considerations and several treatment modalities for hiccups is presented.

(Arch Otolaryngol Head Neck Surg. 1992;118:1115-1119)

Author Affiliations
From the Department of Otolaryngology, Head, and Neck Surgery, The Manhattan Eye, Ear, and Throat Hosptial (Dr Loft); and the New York Hospital—Cornell Medical Center (Dr Ward).

Footnotes
Accepted for publication December 30, 1991.

Reprint requests to the Department of Otolaryngology, Head, and Neck Surgery, The Manhattan Eye, Ear, and Throat Hospital, 210 E 64th St, New York, NY 10021 (Dr Loft).

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