Is there a specific straw that can help cure hiccups?

The HiccAway Straw Is Effective for Treating Hiccups

The HiccAway straw, a specialized forced inspiratory suction and swallow tool (FISST), is effective for treating hiccups with a reported success rate of over 90% in clinical studies. This device works by creating enough suction pressure to stimulate both the phrenic and vagus nerves simultaneously, effectively resetting the hiccup reflex arc.

Understanding Hiccups

Hiccups (singultus) are involuntary contractions of the diaphragm followed by sudden closure of the glottis, producing the characteristic "hic" sound. They result from a reflex arc involving:

• Afferent limb: Phrenic, vagal, and sympathetic nerves
• Central processor: Hiccup center in the midbrain
• Efferent limb: Phrenic nerve to diaphragm and nerves to the glottis

Evidence for the HiccAway Straw

The HiccAway straw works through a dual mechanism:

1. Creating forced inspiratory effort against resistance (stimulating the phrenic nerve)
2. Triggering immediate swallowing (stimulating the vagus nerve)

This combination effectively interrupts the hiccup reflex arc by "resetting" the neural pathways involved.

Treatment Algorithm for Hiccups

For Brief, Self-Limited Hiccups:

1. First-line: Physical maneuvers
   • HiccAway straw or similar FISST device
   • Forced expiratory technique (huffing) without glottic closure
   • Breath holding techniques
   • Stimulation of the uvula/pharynx

For Persistent Hiccups (>48 hours):

1. Identify and treat underlying causes:

   • Gastroesophageal reflux disease (GERD)
   • Gastric distention
   • Central nervous system disorders
   • Metabolic disorders
   • Medication side effects

2. Pharmacological treatment:

   • First-line: Baclofen (5-10 mg three times daily)
   • Second-line: Gabapentin (300-900 mg daily in divided doses)
   • Third-line: Chlorpromazine (25-50 mg IV or oral)
   • Alternative: Metoclopramide (10 mg three times daily)

Common Pitfalls and Caveats

• Avoid chlorpromazine as first-line therapy despite being the only FDA-approved medication for hiccups, as it has significant side effects including sedation, hypotension, and extrapyramidal symptoms
• Be cautious with baclofen in elderly patients due to risk of confusion and sedation
• Monitor for adverse effects of all pharmacological treatments
• Don't overlook treatable underlying causes such as GERD or gastric distention
• Avoid digital manipulation of the pharynx in unconscious patients due to risk of injury

Special Considerations

For intractable hiccups (>2 months), consider referral for specialized interventions:

• Phrenic nerve block
• Acupuncture
• Hypnosis
• Surgical intervention in severe cases

The HiccAway straw represents a non-pharmacological, low-risk intervention that can be tried before resorting to medications with potential side effects. Its mechanism of action directly addresses the neurophysiological basis of hiccups by simultaneously stimulating the key nerves involved in the hiccup reflex arc.