Neuromodulation of the Stellate Ganglion and Treatment of Intractable Hiccups

University of Maryland, Department of Anesthesiology, Division of Pain Medicine Ireon LeBeauf, PhD, MD, Seung Lee, MD, MBA, Kanchana Gattu, MBBS, Thelma Wright, MD, JD, MBA

Hiccups are the result of sudden, irregular contractions of the diaphragm followed by closure of the larynx resulting in the pathognomonic ‘hic’ sound. Intractable medically refractory hiccups are defined as hiccups lasting for more than one month. Intractable hiccups (IH), while rare, are more than a benign nuisance. Typically, a self/time-limited condition, IH can be a significant source of patient morbidity and mortality contributing to nutritional deficiencies, insomnia, and psychological distress. Lesions to the reflex arc, including the midbrain, phrenic, vagus and intercostal sympathetic nerves, exacerbated by various neurological, gastrointestinal, and pulmonary pathologies have been implicated in the etiology of IH. IH has also been linked to infectious disease, metabolic/toxic causes, surgery, and psychosomatic illness.