Laryngorhinootologie 2017; 96(07): 446-455
DOI: 10.1055/s-0043-104086
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Singultus – Diagnostik und Therapie

Singultus – Diagnostic Workup and Therapy
Ohlrich Marcus
,
Georg Royl
Further Information

Publication History

Publication Date:
02 August 2017 (online)

Zusammenfassung

Der Schluckauf (Singultus) ist ein reflektorischer Bewegungsablauf mit diffus im Thorax verteilten Afferenzen und Efferenzen und kontrovers diskutierter funktioneller Relevanz. In seiner physiologischen Form handelt es sich um eine meist spontan sistierende Bagatellbeschwerde, die nur selten zum Arztkontakt führt. Ein anhaltender quälender Singultus kann jedoch zu einer erheblichen Beeinträchtigung der Lebensqualtiät führen. Ein solcher chronischer Singultus wird im Allgemeinen durch eine Dauer von mehr als 48 h definiert. Häufigste zugrundeliegende Erkrankung ist der gastroösophageale Reflux. Die weiteren Ursachen für einen chronischen Singultus sind vielfältig und betreffen multiple Organsysteme mit zum Teil schwerwiegenden Grunderkrankungen. In einigen Fällen können sich auch neurologische Erkrankungen mit einem Schluckauf präsentieren, zum Teil ist er sogar das einzige Symptom im Rahmen der Erstmanifestation. In der zerebralen Bildgebung findet sich dann häufig eine Läsion der Medulla oblongata. Eine Neuromyelitis optica und ein ischämischer Hirninfarkt mit Wallenbergsyndrom sind 2 häufigere zugrundeliegende neurologische Erkrankungen, aber auch andere entzündliche und vaskuläre Erkrankungen und Tumorerkrankungen des zentralen Nervensystems sind beschrieben. Für ein optimales evidenzbasiertes Management der Diagnostik und Therapie des chronischen Singultus gibt es keine hinreichenden Daten. Die Suche nach der Grunderkrankung erfordert oft ein interdisziplinäres Vorgehen von Internisten, Neurologen und HNO-Ärzten. Bereits vor Abschluss der Diagnostik oder bei nicht behebbarer Ursache kann eine symptomatische Therapie erforderlich sein. Der anhaltende Schluckauf stellt auch ein häufiges Problem in der onkologischen Palliativversorgung dar. Die medikamentöse Therapie des Singultus ist oft diffizil. Protonenpumpenhemmer oder Prokinetika bei gastroösophagealer Ursache bzw. Baclofen mit oder ohne Gabapentin bei anderer Ursache gehören dabei zu den Mitteln der ersten Wahl. Weitere Alternativen sind andere Antikonvulsiva, Neuroleptika, Antidepressiva und Kalziumantagonisten. Für den therapierefraktären Verlauf stehen grundsätzlich auch invasive Verfahren wie z. B. die selektive Phrenicusblockade zur Verfügung. Insgesamt wären mehr Studien zum Singultus wünschenswert, um der therapeutischen und diagnostischen Herausforderung gerecht zu werden, die dieses Symptom für Neurologen darstellen kann.

Abstract

A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the first manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other inflammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal reflux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists.

 
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