Combined percutaneous auricular vagus nerve stimulation and ultrasound-guided phrenic nerve block for persistent hiccups: A case report

RATIONALE: Persistent hiccups lasting more than 48 hours are rare but can markedly impair quality of life. Conventional therapies are often limited by transient efficacy, side effects, invasiveness, highlighting the need for safer and more effective options. PATIENT CONCERNS: A 62-year-old male with chronic hepatitis B, hypertension, type 2 diabetes, prior pulmonary tuberculosis, and gastrointestinal disorders presented with fever for 7 days and persistent hiccups for 4 days, occurring at a frequency of 40 to 50 times per minute. Symptoms significantly interfered with eating, sleeping, and daily activities. DIAGNOSES: After excluding central nervous system and metabolic causes, the patient was diagnosed with persistent hiccups associated with pulmonary infection and gastrointestinal dysfunction. INTERVENTIONS: An initial ultrasound-guided phrenic nerve block provided transient relief for about 4 hours. Subsequently, combined therapy with daily phrenic nerve block and twice-daily percutaneous auricular vagus nerve stimulation (aVNS) was administered for 3 consecutive days. OUTCOMES: By day 7, the hiccups had resolved completely, with the hiccups assessment instrument score decreasing from 9 to 0 and the Pittsburgh sleep quality index score improving from 16 to 2. After initiation of aVNS, the patient was followed up for 1 month after discharge. No recurrence of persistent hiccups, delayed complications, or treatment-related adverse events were observed during follow-up. LESSONS: This case suggests that ultrasound-guided phrenic nerve block combined with aVNS may offer a minimally invasive, safe, and effective treatment option for persistent hiccups unresponsive to conventional therapy. Larger studies are warranted to validate efficacy and long-term outcomes.