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Symptoms and Signs – Differential Diagnosis of Hiccups
Benign
Gastric distension: over eating, carbonated beverages, aerophagia, gastric
insufflation during endoscopy
Excessive alcohol ingestion and tobacco use; sudden changes in ambient or GI
temperature, sudden excitement
Phrenic nerve irritation
Neck masses (e.g. goitres), mediastinal masses
Diaphragmatic abnormalities:, e.g. gastro-oesophageal reflux, hiatus hernia,
intra-operative manipulation
Subdiaphragmatic:, e.g. subphrenic abscess
Vagus nerve irritation
Irritation of the recurrent laryngeal nerve by pharyngitis, laryngitis, tumours of
the neck
Irritation of the auricular branch of the vagus by foreign bodies touching the
tympanic membrane
Toxic/metabolic
Uraemia, alcohol intoxication, general anaesthetic
CNS disorders
Vascular, infective or structural lesions releasing the normal inhibition of the
hiccup reflex
Psychogenic
Anxiety, malingering
Benign
Gastric distension: over eating, carbonated beverages, aerophagia, gastric
insufflation during endoscopy
Excessive alcohol ingestion and tobacco use; sudden changes in ambient or GI
temperature, sudden excitement
Phrenic nerve irritation
Neck masses (e.g. goitres), mediastinal masses
Diaphragmatic abnormalities:, e.g. gastro-oesophageal reflux, hiatus hernia,
intra-operative manipulation
Subdiaphragmatic:, e.g. subphrenic abscess
Vagus nerve irritation
Irritation of the recurrent laryngeal nerve by pharyngitis, laryngitis, tumours of
the neck
Irritation of the auricular branch of the vagus by foreign bodies touching the
tympanic membrane
Toxic/metabolic
Uraemia, alcohol intoxication, general anaesthetic
CNS disorders
Vascular, infective or structural lesions releasing the normal inhibition of the
hiccup reflex
Psychogenic
Anxiety, malingering
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