What is Cricopharyngeal Muscle Dysfunction?
When a person swallows, the upper esophageal sphincter (UES), sometimes called the cricopharyngeus, which is a semi-circular muscle in the neck, relaxes to permit food to pass through to the esophagus and eventually the stomach. When not swallowing, the UES is usually contracted.
If Cricopharyngeal Muscle Dysfunction (CMD) is present, the UES does not relax, or only partially relaxes during swallowing, causing food to become blocked from entering the esophagus and stomach. CMD usually causes more issues with swallowing foods than it does with swallowing liquids, as liquids can more easily pass through the partially relaxed UES.
Causes of Cricopharyngeal Muscle Dysfunction
CMD can occur for a multitude of reasons or causes. These causes can include the following:
- A side effect of the normal aging process
- Damage or dysfunction of the nerves that signal the USE
- Damage to the UES muscle, such as from hypertrophy, scarring, trauma, heartburn, or radiation therapy
Symptoms and Diagnosis of Cricopharyngeal Muscle Dysfunction
Symptoms for CMD may include the following:
- Choking or coughing while you eat or drink
- Difficulty swallowing larger pieces of food
- Feeling afraid to eat
- A feeling that is food stuck in your throat
- Aspiration pneumonia
Diagnosis of CMD will usually involve your ENT specialist examining your throat by inserting a small camera through your nose. An x-ray swallowing test may also be ordered to test the functionality of the UES.
The x-ray swallowing test will involve swallowing different barium-coated pills while x-ray videos are recorded. The ENT specialist will observe your esophagus to determine if you have CMD.
Treatments for Cricopharyngeal Muscle Dysfunction
There are varying treatment options depending on the severity of symptoms and the root cause of your CMD.
Temporary treatment options for CMD may include one of the following:
- Inserting a device down your throat to dilate or stretch the UES.
- BOTOX injections into the UES, which can provide temporary improvements to the function of the UES for approximately three to six months
- Prescribed medications
The temporary treatment options listed above will usually greatly improve your ability to swallow properly; however, they will generally not permanently cure your CMD. If you and your ENT specialist decide on a permanent solution for CMD, treatment may involve a procedure called cricopharyngeal myotomy, or cutting of the UES. The myotomy can be performed through the mouth (i.e., without an incision), or through the skin of the neck.