Nasocardiac reflex-induced resolution of persistent hiccups via intranasal swab stimulation: A case report.

Hiccups are a common respiratory reflex experienced by most individuals at some point in their lives and are typically self-limiting. In emergency department treatment, vagal maneuvers are usually the first-line approach; if unsuccessful, pharmacologic therapies are considered. We present a case of persistent hiccups successfully resolved through vagal stimulation induced by the nasocardiac reflex following nasopharyngeal stimulation with an intranasal swab. A 31-year-old female presented to the emergency department with a 72-h history of hiccups. Prior to arrival, she had attempted various vagal maneuvers without relief. Nasopharyngeal stimulation was performed via the right nostril using a polymerase chain reaction (PCR) swab. The hiccups ceased approximately five seconds into the procedure. Additionally, the patient experienced a 28 % decrease in heart rate and a 22 % reduction in systolic blood pressure compared to pre-procedure values. The patient was contacted by phone at 48 h, and no recurrence was reported. Although various vagal maneuvers are utilized in the management of hiccups, the role of the nasocardiac reflex has not been clearly defined. Nasopharyngeal stimulation using a PCR swab may offer a simple and safe alternative for patients with persistent hiccups. This approach also raises the possibility that PCR-induced nasocardiac reflex stimulation could serve as an alternative method in other conditions where vagal maneuvers are used, such as supraventricular tachycardia. Moreover, this method may reduce patient discomfort and potentially decrease emergency department visits.