Most patients with benign hiccups resolve spontaneously or with simple maneuvers, do not seek medical attention, and do not require specific diagnosis. Patients with persistent hiccups often seek medical attention, occasionally in the emergency department. 26
The evaluation of persistent hiccups should start with a history to determine whether a specific event was associated with the onset. Are the hiccups persistent during sleep? Persistence during sleep suggests an organic cause, and resolution during sleep suggests a psychogenic cause, although this distinction is not absolute. 24 Inquiries should be made concerning general anesthesia, surgical procedures, and several metabolic diseases that are associated with persistent hiccups. As noted above, the external auditory canal should be carefully examined. A chest radiograph should be done to evaluate for possible intrathoracic pathology. Fluoroscopy can be useful to evaluate to unilateral versus bilateral diaphragmatic movement during hiccups.
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