A person with cricopharyngeal dysfunction may experience difficulty swallowing or a feeling of something being stuck in their throat. This is because the sphincter does not open properly. Treatment options include surgery, exercises, and Botox injections.
In this article, we discuss what cricopharyngeal dysfunction is. We also list symptoms and causes of the condition and explore potential treatments.
Cricopharyngeal dysfunction is relatively rare. It affects the muscle at the top of the throat called the cricopharyngeal muscle (CPM).
This causes problems with the upper esophageal sphincter (UES). The UES is a valve at the top of the esophagus, or food pipe, which is the tube that connects the throat to the stomach.
The CPM is usually closed until a person swallows. If a person has cricopharyngeal dysfunction, the CPM does not relax to allow food or liquid to enter the esophagus.
The CPM stops air from entering the esophagus when a person is not eating or drinking. It also stops food, liquids, and stomach acids from coming back up the esophagus and accidentally entering the lungs.
Cricopharyngeal dysfunction is most common in older adults.
A person with cricopharyngeal dysfunction may experience:
The symptoms of cricopharyngeal dysfunction in children can include:
Children may also experience cyanosis, which is when their skin appears blue.
Cricopharyngeal dysfunction happens because the sphincter does not open properly as a result of incoordination or weakness in the muscles surrounding it. This can occur due to a number of reasons.
Nerve signaling pathway changes
The nerve signaling pathways that tell the CPM when to relax and contract can change, causing cricopharyngeal dysfunction.
Trauma, surgery, or radiation
Any process that causes scarring can lead to immediate or delayed cricopharyngeal dysfunction. For example, according to a 2020 study, cricopharyngeal dysfunction can occur years after surgery.
Radiation may cause scarring of the CPM as well, which can result in cricopharyngeal dysfunction.
Learn more about radiation therapy here.
Stroke can cause brain damage that impairs the ability to use the nerves controlling the upper esophageal sphincter.
According to a 2016 study, 5.2% of people who have had an acute stroke also develop cricopharyngeal dysfunction.
Cricopharyngeal dysfunction may occur in people if they have an enlarged, or prominent, CPM. This may be the result of the following:
No known cause
Sometimes, the condition may occur on its own for unknown reasons.
Doctors call this idiopathic cricopharyngeal dysfunction.
Other factors that can affect CPM
Posture can impact cricopharyngeal function.
Additionally, stress can worsen symptoms in people with cricopharyngeal dysfunction.
Understanding what has caused cricopharyngeal dysfunction will help doctors treat it in the best way possible.
Cricopharyngeal dysfunction will not go away with exercises or behavioral adjustments, and surgery may be the best option. However, some methods may help a person alleviate their symptoms.
Following the advice of their doctor, a person can also try the following:
- The Shaker exercise: This exercise involves lying down, raising the head without lifting the shoulders to look at the feet, and holding for 60 seconds.
- The Mendelsohn maneuver: This exercise involves holding the larynx, or the voice box, for 3–5 seconds after swallowing.
A person can also adjust the type of food they eat to make swallowing easier. For instance, they can thicken drinks using powders, as well as soften harder foods.
Botulinum toxin, or Botox, injections can help relax or partially paralyze the upper esophageal sphincter.
A person will need to repeat the treatment with Botox injections every 3–6 months. It is also important to note that such injections work only for some causes of cricopharyngeal dysfunction.
There are several ways to treat cricopharyngeal dysfunction surgically.
Dilatation is another word for stretching. Stretching the esophagus increases its size and loosens the CPM so that food and liquids can pass more easily when a person swallows.
A balloon catheter stretches the esophagus and inflates. During this operation, the patient will be under general anesthesia.
Dilatation can significantly improve symptoms. A 2015 study found that this type of surgery improved sphincter opening for more than 6 months.
However, a person will need to have the procedure repeated over time, as it is not a permanent solution.
Cricopharyngeus muscle myotomy
Myotomy is a surgical procedure that involves cutting through muscle.
A cricopharyngeal myotomy involves cutting the CPM so that it loosens and makes swallowing easier.
To carry out this procedure, surgeons make a small incision in the neck.
Endoscopic cricopharyngeal myotomy
An endoscopic cricopharyngeal myotomy may involve the use of carbon dioxide (CO2) lasers to improve cricopharyngeal dysfunction.
The laser cuts through the CPM and releases the tension so that food and liquids can pass into the esophagus more easily.
During endoscopic cricophrayngeal myotomy, surgeons enter the laser into the body through the mouth, making the procedure minimally invasive.
Stapling in order to cut the CPM can be one of the less invasive surgical options to treat cricopharyngeal dysfunction that doctors may choose if a person has a Zenker’s diverticulum.
A Zenker’s diverticulum is a pouch that forms in the throat because of extra pressure a person can create when swallowing. However, it is rare and most commonly occurs in older adults.
A 2015 review of the cricopharyngeal myotomy procedure analyzed a retrospective comparative study on 153 patients who had undergone cricopharyngeal myotomy surgery.
Only 6% of people who had CO2 laser surgery had recurring symptoms, compared with 26% of people who had stapler surgery.
A 2015 study examined the efficacy of balloon dilatation and laser myotomy. It found that the opening of the upper esophageal sphincter increased from 5.6 millimeters (mm) to 8.4 mm in the 6 months following the procedures.
A person can see an otolaryngologist — commonly called an ear, nose, and throat doctor — to receive a diagnosis for cricopharyngeal dysfunction.
There is a range of exams a doctor may order to diagnose cricopharyngeal dysfunction, as well as the cause of a person’s condition.
X-ray swallow test
An X-ray swallow test — also known as modified barium swallow, esophagogram, or video fluoroscopic swallow study — uses barium to make certain areas in the body more visible on an X-ray.
A person will swallow a small amount of barium mixed with water or oil. This coats the esophagus and makes it easier to see in the X-ray image.
Learn more about barium swallows here.
Esophageal manometry measures the muscle contractions that occur when a person swallows, and shows the coordination of muscles during swallowing.
A manometry can show whether the muscles that help move food down the esophagus and stop food in the stomach from coming back up are working properly.
During this procedure, a doctor may numb the inside of the nose. They will pass the tube through the nose into the stomach and back up through the esophagus. They will then ask the person to swallow.
A person with cricopharyngeal dysfunction will feel as though they have something stuck in their throat that they cannot get rid of.
Cricopharyngeal dysfunction can also make it difficult or painful for a person to swallow. Additionally, they may experience choking episodes. As a result, they may feel anxious about eating and experience weight loss.
Cricopharyngeal dysfunction occurs due to muscular, neurological, or degenerative conditions, as well as hypertrophy or scarring in the CPM.
Separate conditions, such as stroke, can affect muscle function as well.
However, it is possible for a person to develop cricopharyngeal dysfunction spontaneously, with no clear cause.
There are treatments to improve cricopharyngeal dysfunction, such as Botox injections, surgery to release the muscle, and therapeutic swallowing exercises.