Individuals with Cricopharyngeal Dysfunction have a blockage in their throat which prevents solid food from getting down to the stomach. The esophagus (commonly thought of as the swallowing tube) has two muscular sphincters that control the passage of food down into the stomach. The upper esophageal sphincter is located in the neck, about three inches below the Adam’s apple. It is a semi-circular muscle called the cricopharyngeus. This is the muscle that is the culprit behind Cricopharyngeal Dysfunction.
In normal function, the cricopharyngeus muscle is always contracted, relaxing only briefly to allow food or liquid to pass down to the stomach, and then contracting again. This contraction prevents the reflux of foods from the esophagus into the throat. In aging people, the cricopharyngeus muscle can have trouble relaxing and this blocks the passage of food into the stomach.
Cricopharyngeal Dysfunction doesn’t come on all at once. It usually begins with the person feeling that vitamins or solid foods are lodging down around the larynx (the voice box). Initially this is discounted as an aberration, but the problem progresses to the point where the person is limited to only a soft or liquid diet.
Symptoms of Cricopharyngeal Dysfunction:
- Difficulty swallowing
- Difficulty ingesting solid foods
- A feeling that food is continually stuck in the throat
Sometimes a pouch forms in the esophagus just above the rigid cricopharyngeus muscle. This is basically like a hernia. It is caused by the pressure of swallowing running up against the contracted muscle. This can force the wall of the esophagus to balloon outward, creating a pouch. This pouch is called the Zenker’s Diverticulum. Food collects there and, if the pouch is severe, can be regurgitated.
X-rays taken while the patient is swallowing barium are effective for diagnosing Cricopharyngeal Dysfunction. Lateral x-rays clearly show the barium being blocked by the contracted muscle. Laryngoscopy will also show the problem.
Treatment for Cricopharyngeal Dysfunction
There are two ways to treat this swallowing problem — Botox injections or surgery. Both are effective, but the Botox approach is only temporary.
BOTOX works by blocking the messages sent to the brain by the nerves in a muscle, keeping the muscle from contracting. Just as it works to stop muscle contractions that cause wrinkles, Botox can force the cricopharyngeus muscle to relax and stop blocking the esophagus. But the body eventually absorbs Botox, so its effects last around four months. At that point, another injection is required to keep the throat functioning properly. Still, for those who don’t want surgery, Botox is a good alternative.
Cricopharyngeal myotomy is the term for surgery to divide or cut across the cricopharyngeus muscle in order to break its grip. This is a straightforward surgical procedure performed through the mouth with a CO2 laser. The muscle is cut and normal swallowing returns immediately. The Zenker’s diverticulum, if one exists, doesn’t need to be addressed once normal function returns. Occasionally, a person’s anatomy requires surgery to be made through a neck incision, but these conditions are rare.
Laser surgery is minimally invasive and makes for very rapid healing. Only one or two days of hospitalization are required, and patients can typically begin eating the morning after surgery.
If you’re getting older and feel as if you’re continually having something caught in your throat, you may have the beginnings of Cricopharyngeal Dysfunction. Call us at Coastal Ear, Nose, and Throat; our experts will diagnose and treat your condition and get you back to eating your old diet very soon.