In many cases, hiccups are normal because the eustachian tube is physiologically open and closed, and when it is open, airflow enters the middle ear through the eustachian tube. If the patient experiences pain inside the ear during hiccups, or if he or she experiences stuffiness or hearing loss, he or she needs to go to an ENT doctor to check the tympanic membrane to see if there is tympanic membrane invagination, tympanic membrane congestion, or even tympanic membrane perforation. If there is hearing loss, a pure tone hearing threshold and acoustic conductance test is recommended to consider the possibility of secretory otitis media. In some patients, ringing inside the ear during hiccups does not exclude the possibility of cerumen in the ear canal, because hiccups stimulate the cerumen to move and stimulate the eardrum, resulting in a ringing sound in the ear.