Cricopharyngeal Muscle Dysfunction - Causes, Diagnosis, and Treatment

Introduction

The cricopharyngeal muscle is located in the throat. It separates the esophagus from the throat. When this muscle malfunctions or is impaired, swallowing becomes difficult. A valve called the upper esophageal sphincter (UES) or pharyngoesophageal segment (PES) is present in the top part of the esophagus.

Unlike other muscles in the body, the cricopharyngeal muscle remains flexed and tightly closed until the nerve signals it to relax. This prevents food and water from the esophagus from inadvertently entering the throat, the windpipe, and then the lungs. For food, liquid, and saliva to enter the esophagus, the cricopharyngeal muscle needs to be relaxed.

What Causes Cricopharyngeal Muscle Dysfunction?

CPM and UES dysfunction can arise from different causes, including the natural aging process or alterations in the CPM or nerve signaling pathways. Factors such as muscle scarring (fibrosis) and muscle enlargement (hypertrophy) due to radiation therapy or trauma, reflux (heartburn), and stroke can all impair the swallowing mechanism at the UES. To diagnose CPM and/or UES dysfunction, the ENT specialist or otolaryngologist may inspect the throat and larynx (voice box) using a small flexible camera inserted through the nose.

Additionally, the ENT specialist might order diagnostic tests such as a modified barium swallow X-ray, an esophagram, and/or manometry (pressure testing) of the valve area. During a modified barium swallow, also known as a Videofluoroscopic Swallow Study (VFSS), one consumes various barium-coated foods, liquids, and pills while a speech-language pathologist records X-ray videos. In an esophagram, a radiologist uses X-rays to examine the esophagus as one swallow barium to assess its function. In CPM dysfunction, a narrowing of the valve might be observed, though a narrowed PES may not necessarily be abnormal or need intervention. Manometry, a test that measures throat and esophageal pressures during swallowing, involves inserting a thin tube through the nose into the esophagus and having patients swallow water. In cases of CPM dysfunction, the valve may exhibit high pressures at rest and/or during swallows.

What Are the Symptoms of Cricopharyngeal Muscle Dysfunction?

If someone has cricopharyngeal dysfunction, one may have the following signs and symptoms:

• Feeling while having food that the food is getting stuck at the back of the throat.

• The person needs to put extra effort into swallowing food, liquid, or saliva.

• Coughing when eating or drinking.

• When the food particle is large, the person finds it unable to swallow.

• Choking episodes.

• Aspiration pneumonia (infection of the lungs when food particles or water enters the airways instead of being swallowed).

• Fear of having food.

• Feeling that there is some foreign particle or lump in the throat.

• Swelling in the neck region.

• Feeling extra pressure in the area below Adam's apple.

Who Does Cricopharyngeal Muscle Dysfunction Affect?

Cricopharyngeal muscle dysfunction can affect people of all ages, including children. It can be associated with other medical conditions. Many people who have suffered a stroke can develop cricopharyngeal muscle dysfunction.

Can Anxiety Cause Throat Spasms?

Yes, anxiety can cause many physical symptoms, among which throat tightness is also one of them. Throat tightness is one of the common symptoms seen during anxiety attacks. The symptoms are worsened during an episode of anxiety and also when the patient is stressed.

How Is Cricopharyngeal Muscle Dysfunction Diagnosed?

The doctors take a detailed history of the symptoms and the severity of the condition. Upon visual examination, the specialist will be able to see some pooling of food and saliva in that area. The other diagnosing tests that are done to diagnose cricopharyngeal muscle dysfunction are:

• Esophageal Manometry - Esophageal manometry is tested to measure the rhythmic contraction, coordination, and force exerted by the muscle during swallowing in the esophagus. The throat and nose are numbed during this procedure. In this procedure, a thin, flexible catheter that has a sensor is passed through the nose down the esophagus to the stomach. The patients will be asked to take a small sip of water and swallow according to their instructions during the test.

• Modified Barium Swallow Study (MBSS) - During this test, they were asked to swallow various substances that are coated with barium. These barium-coated things that are swallowed can be seen in the X-rays in white color, which will help the examiner to identify how the substance is passing through the mouth, pharynx, and esophagus. This test will help to identify if the shifters are working properly or not. One can identify if the sphincter is relaxed for the food or liquid to pass through it or if it blocks the food.

• Upper Endoscopy Procedure - A thin, flexible tube with a camera fitted at the end and sometimes with a video recorder at the end so that they can see as well as record what they see as it passes down the throat. This will allow the doctor to examine the throat and esophagus in great detail.

What Are the Treatments for Cricopharyngeal Muscle Dysfunction?

There are various ways to treat cricopharyngeal muscle dysfunction. They are:

• Dilatation (Stretching) - These dilatation procedures generally do not produce a permanent result; they provide a trial period to see whether the treatment will be helpful.

• BOTOX Injections - Along with stretching, the BOTOX injection gives temporary relief from the conditions for about a period of three to six months by causing partial paralysis or weakening of the cricopharyngeal muscle.

• Cricopharyngeal Myotomy (Cutting) - The cutting of the cricopharyngeal muscle can be done using a laser or using instruments either endoscopically (through the mouth without giving any incision on the neck) or through the neck skin, which depends upon the patient.

• Physical Therapy - The symptoms of cricopharyngeal dysfunction can be eased by doing certain exercises that will help them relax the affected muscles.

• Medications - Certain muscle relaxants like valium can be given. These medicines help to relax the muscles in spasms so that the food and liquid can pass down to them.

• Counseling - If stress is a contributing factor to this condition, then counseling can help the condition. Managing stress can reduce, in some cases, it can eliminate the symptoms of cricopharyngeal muscle dysfunction.

How to Prevent Cricopharyngeal Muscle Dysfunction?

Cricopharyngeal muscle dysfunction cannot always be prevented. However treating the underlying conditions, which can be a contributing factor to this condition, will help to prevent this condition. Also, managing stress and anxiety can help ease the symptoms of this condition.

Conclusion

Cricopharyngeal muscle dysfunction is not a serious medical condition, but it can become further complicated with time. But they can be very uncomfortable for the patient. The patient even might develop a fear of food, thinking about the difficulty of swallowing. If someone is suffering from these symptoms, schedule an appointment with an ear, nose, and throat specialist. They can identify the cause of this condition and start the treatment immediately.