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What is Cricopharyngeal Dysfunction?
Written by Medicover Team and Medically Reviewed by Dr Neha B L , ENT
Cricopharyngeal dysfunction is a condition where a muscle in the throat, the cricopharyngeus muscle, does not work as it should. This muscle is part of the upper esophageal sphincter (UES) and helps move food and liquids from the throat into the esophagus when you swallow.
If the muscle doesn't relax properly, food and drink may get stuck in the throat. This can cause difficulty swallowing (dysphagia), a feeling of a lump in the throat, or even lung infections if food enters the airway.
Although it's not very common, this condition can greatly affect daily life, especially in older adults or people with neurological conditions.
What Happens in Cricopharyngeal Dysfunction?
Normally, the cricopharyngeus muscle stays closed and only opens during swallowing. In cricopharyngeal dysfunction, the muscle might:
- Not open at all (achalasia)
- Spasm without control
- Become enlarged (hypertrophy)
All of these problems make it harder for food to pass into the esophagus.
Cricopharyngeal Dysfunction vs. Dysphagia
While cricopharyngeal dysfunction is a specific cause of dysphagia, not all dysphagia cases are due to cricopharyngeal issues. Dysphagia can result from various other conditions affecting the muscles and nerves involved in swallowing. Therefore, accurate diagnosis is vital to determine the underlying cause and appropriate treatment.
What Are the Different Types of Cricopharyngeal Dysfunction?
There are different types of cricopharyngeal dysfunction, each with unique causes and implications.
Cricopharyngeal Achalasia
- This occurs when the cricopharyngeal muscle fails to relax properly, obstructing the passage of food into the esophagus.
- Symptoms: Trouble swallowing, feeling of food stuck in the throat, and regurgitation.
- Common causes: Aging and neurological diseases.
Cricopharyngeal Spasm
- This is characterized by involuntary contractions of the cricopharyngeal muscle.
- Symptoms: Tightness, trouble swallowing, and a "lump in the throat" (Globus).
- Triggers: Often worsens with stress or anxiety.
Cricopharyngeal Muscle Hypertrophy
- This type involves thickening or overdevelopment of the cricopharyngeal muscle.
- The condition can lead to persistent swallowing issues and is often identified during imaging or endoscopic procedures.
What are the Symptoms of Cricopharyngeal Dysfunction?
The symptoms of cricopharyngeal dysfunction can vary among individuals but often include:
- Difficulty swallowing (dysphagia)
- Sensation of a lump or fullness in the throat
- Regurgitation of food or liquids
- Coughing or choking during meals
- Unexplained weight loss
- Recurrent respiratory infections due to aspiration
- Throat Pain or Tightness
- Regurgitation
- Weight Loss
These symptoms can significantly impact a person's nutrition and overall health, making timely diagnosis and management essential.
Cricopharyngeal Dysfunction Symptoms in Children
- Feeding Difficulties
- Choking Episodes
- Slow Growth
- Irritability During Eating.
- Difficulty Swallowing
- Choking
- Coughing
- Recurring Pneumonia
- Nasal Congestion
What Are the Common Causes for Cricopharyngeal Dysfunction?
The exact cause of cricopharyngeal dysfunction is not always clear, but several factors may contribute:
- Neurological Disorders: Conditions that affect the nervous system, such as Parkinson's disease, multiple sclerosis, or a stroke, can disrupt the normal function of the cricopharyngeus muscle.
- Muscle Disorders: Disorders that directly impact muscle function, such as muscular dystrophy or myasthenia gravis, can also lead to cricopharyngeal dysfunction.
- Aging: As individuals age, changes in muscle tone and coordination can naturally occur, sometimes leading to dysfunction of the cricopharyngeal muscle.
- Structural Abnormalities: Structural issues, such as a cricopharyngeal bar (a protrusion of the muscle into the esophageal opening), can obstruct swallowing.
- Idiopathic Cases: In some cases, the cause remains unknown.
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Get Second OpinionHow is Cricopharyngeal Dysfunction Diagnosed?
Accurate diagnosis of cricopharyngeal dysfunction requires a thorough evaluation by a medical professional, often involving:
- Clinical Evaluation: A detailed medical history and examination can provide critical insights into the symptoms and potential causes of the dysfunction.
- Imaging Studies: Tests such as a barium swallow study or video fluoroscopic swallowing study can visualize the swallowing process and identify any abnormalities in muscle function.
- Manometry:Esophageal manometry measures the pressure within the esophagus and the function of the esophageal muscles, including the cricopharyngeus.
Cricopharyngeal Dysfunction Muscle Treatment
The Cricopharyngeal Muscle Dysfunction Treatment approach depends on the severity of symptoms and the underlying cause. Options may include:
- Dietary Modifications: For mild cases, altering the consistency of foods and liquids can help manage symptoms and reduce the risk of aspiration.
- Swallowing Therapy: Working with a speech-language pathologist can help individuals learn swallowing techniques and exercises to improve muscle function.
- Medications: In some cases, medications that relax the cricopharyngeus muscle or treat underlying conditions can be beneficial.
Surgical Options for Cricopharyngeal Dysfunction
When conservative treatments are insufficient, surgical intervention may be necessary. Surgical options include:
- Cricopharyngeal Myotomy: This procedure involves cutting the cricopharyngeus muscle to relieve the obstruction and improve swallowing. It is often successful in reducing symptoms of dysphagia.
- Botulinum Toxin Injection: Botulinum toxin (Botox) can be injected into the cricopharyngeus muscle to temporarily relax it, providing relief from symptoms.
- Cricopharyngeus Muscle Myotomy: This involves making an incision in the muscle (the cricopharyngeus) to help it relax and facilitate swallowing. This new treatment is particularly beneficial for patients who have significant swallowing problems and is often permanent. This surgery is done under general anesthesia and reports high rates of success.
- Endoscopic Cricopharyngeal Myotomy: A minimally invasive surgery using an endoscope inserted through the mouth. The muscle is divided without external cuts.
When to See a Doctor for Cricopharyngeal Dysfunction?
If you experience persistent symptoms of cricopharyngeal dysfunction or strep throat, it's important not to ignore them. You should seek medical attention if:
- Sore throat, difficulty swallowing, or hoarseness lasts more than 3 to 5 days
- You develop fever, swollen glands, or white patches in the throat
- You feel like food is stuck in your throat or chest (a common symptom of cricopharyngeal dysfunction)
- There is unexplained weight loss or frequent choking/coughing while eating
- You are part of a high-risk group, such as children, older adults, or individuals with weakened immune systems
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Cricopharyngeal Dysfunction Exercises
Specific exercises can help strengthen the muscles involved in swallowing, improve coordination, and alleviate symptoms like choking or food sticking in the throat.
The Shaker Exercise
The Shaker exercise,which promotes the exercise of the suprahyoid muscles responsible for opening the upper esophageal sphincter.
- How to Perform: To perform, one should lie flat on the back with their head slightly above the ground then raise the head, ensuring the shoulder remains in contact with the ground. The individual then looks at the toes for a few seconds then lowers the head. This exercise is done in sets with a duration and number of repetitions having increments.
The Mendelsohn Maneuver
The Mendelsohn maneuver focuses on improving swallowing coordination and prolonging the elevation of the larynx.
- How to Perform: Swallow normally, and at the peak of the swallow, hold the muscles in place by contracting your throat muscles for a few seconds before relaxing. Practice multiple repetitions daily.
Post-Treatment Considerations
Recovery and long-term management include:
- Regular checkups with ENT or gastroenterology specialists
- Swallowing therapy post-surgery to enhance outcomes
- Monitoring for recurrence of symptoms
- Nutritional support, especially in those with significant weight loss or aspiration risk
Our Experience Treating Cricopharyngeal Dysfunction
At Medicover Hospitals, we specialize in diagnosing and treating cricopharyngeal dysfunction, a condition that can cause difficulty or discomfort while swallowing. Our ENT specialists and gastroenterologists work closely to deliver precise assessments using advanced imaging and swallowing studies. From medication to swallowing therapy or minimally invasive procedures, treatment plans are designed to each patient's unique condition. With a focus on relief, safety, and restoring quality of life, we provide complete care in a supportive, patient-centered environment.
