The AAO Journal, 2022/06, 32(2):16. doi: 10.53702/2375-5717-32.2.15, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://meridian.allenpress.com/aaoj/article/32/2/15/482674/LBORC-NUFA-Poster-Abstracts-2022-Students)

Keywords:

case report [736]
hiccup [8]
intractable singultus [2]
OMT [3924]
diaphragm [99]
osteopathic manipulative treatment [3945]

Abstract:

Introduction/Background: The etiology and mechanism of singultus, or “hiccups,” is largely unknown; it is believed to be related to a reflex arc of the vagus, phrenic, and sympathetic nerves. Intractable singultus describes hiccups persisting longer than one month. Current medical literature lacks universally accepted techniques to treat intractable singultus. Application of OMT to treat singultus is limited to two case reports. Case: An otherwise healthy 23-year-old female presented with a 5 year history of intractable singultus. The patient kept a hiccup diary before beginning treatment to track hiccups. In addition to reporting a daily average of 59.5 ± 23.9 hiccups, the patient had distressing associated symptoms: burping, dyspepsia, nausea, back and abdominal pain. After physical exams discovered somatic dysfunction, the patient was treated once a week for four weeks using the following OMT techniques: muscle energy treatment, myofascial release, counterstrain, and high velocity low amplitude treatment. Results: After four treatments of OMT, the patient’s average daily hiccups decreased to 33.5 ± 5.4. Additionally, the patient reported decreased associated symptoms which improved quality of life. Discussion: Addressing intractable singultus with OMT reduced daily hiccups, associated symptoms and improved quality of life. A limitation of the study was interruption of the hiccup diary pretreatment as the patient, a student, transitioned between semesters. Interestingly, our patient’s somatic dysfunction corresponded with the anatomical routes of the phrenic and vagus nerve. This case supports current literature; intractable singultus may be related to dysfunction of the physiological mechanism of the vagus-phrenic-sympathetic reflex arc, illustrating the relationship of structure and function. Intractable singultus diminishes wellbeing; absent medical guidelines for clinical treatment warrants further research applying OMT for managing intractable singultus.