Benign hiccups are generally initiated by gastric distention from food, drinking (especially carbonated beverages), or air. Alcohol ingestion appears to precipitate hiccups by relaxing the relationship between inspiration and glottic closure, making it easier for other stimuli to trigger the reflex. Excessive smoking, a sudden change in environmental temperature, and psychogenic events (excitement or stress) are sometimes associated with hiccups.
Persistent hiccups are usually due to damage or irritation to a branch of the vagus or phrenic nerve. A wide variety of events have been implicated in producing persistent hiccups. One rare but readily treatable stimulus is a foreign body (often a hair) in the external auditory canal that is pressing against the tympanic membrane and stimulating the auricular branch of the vagus nerve. Several drugs—most often steroids and benzodiazepines—have been implicated in inducing hiccups, but a recent review found evidence of etiologic association unconvincing. 25
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