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Why We Hiccup: The Reflex, the Nerves, and the Science

1What a Hiccup Actually Is2The Hiccup Reflex Arc3Muscles and Nerves That Execute the Hiccup4Triggers and Causes of Hiccups5Why the Reflex Exists: Evolutionary and Scientific Explanations
Why the Reflex Exists: Evolutionary and Scientific Explanations

Two Hypotheses for a Reflex With No Job

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Start with the puzzle. Every part of the hiccup reflex already has a job elsewhere: the vagus and phrenic nerves carry sensation, the brainstem generates breathing rhythms, and the phrenic nerve drives the diaphragm. What is unexplained is why these parts are wired into a stereotyped motor program that fires with no obvious purpose. Two hypotheses try to answer that. The amphibian breathing hypothesis says the hiccup is a vestige of gill ventilation: amphibians and lungfish aspirate water across their gills with the glottis closed, then expel it with the glottis open, and that aspiration phase uses muscles homologous to the ones the hiccup uses. The suckling hypothesis says the hiccup is a vestige of a neonatal behavior, helping infants clear swallowed air or coordinate suck, swallow, and breathe. Notice that these are not mutually exclusive: a pattern generator can be inherited from an amphibian ancestor and also be recruited during infancy. So the real question is what evidence each hypothesis predicts, and whether that evidence exists.
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The hiccup reflex has no established function in adult humans. Evolutionary explanations are therefore hypotheses about the origin of the reflex, not descriptions of what it currently does.

The amphibian breathing hypothesis

Amphibians and lungfish ventilate their gills with a two-phase motor pattern: a phase of aspiration with the glottis closed, then a phase of expulsion with the glottis open. The aspiration phase is produced by muscles that are homologous to the muscles the hiccup uses, and the glottic closure matches the hiccup's second mechanical component. The hypothesis holds that the brainstem pattern generator for this pattern was retained in mammals, where it now drives the diaphragm. The hiccup is the vestige: the same motor program, running on mammalian hardware, with no gills to ventilate.

The suckling hypothesis

Infants hiccup far more often than adults, and the reflex is present before birth. One proposal is that hiccups help clear swallowed air from the stomach during feeding, since the diaphragm contraction changes intrathoracic and intra-abdominal pressure while the glottis closes. A related proposal is that the hiccup helps entrain the suck-swallow-breathe rhythm, or that it exercises the neural circuitry that will later generate breathing. On this view the reflex is a developmental program that becomes vestigial after infancy rather than a gill remnant.

The two hypotheses are not mutually exclusive. A brainstem pattern generator can be inherited from an amphibian ancestor and also be recruited during infancy for a suckling-related function. Evaluating them means asking what evidence each predicts and whether that evidence is present.

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