All you need to know about cricopharyngeal spasm
The cricopharyngeus muscle is a circular muscle around the top of the food pipe, the tubular organ that passes food from the mouth into the stomach. The muscle is responsible for opening and closing the food pipe.
In most people with cricopharyngeal spasm, the muscle will still relax enough to allow the esophagus to open for swallowing.
Usually, the condition is considered harmless, but it can cause feelings of discomfort and concern.
- The cricopharyngeus muscle is also known as the upper esophageal sphincter (UES), and the condition can be referred to as UES spasm.
- The cricopharyngeus muscle keeps the esophagus shut, only opening it to allow swallowing.
- Symptoms of spasms include a feeling similar to a continual lump in the throat called globus pharyngeus.
- Over-the-counter medications, including muscle relaxants, may help lessen spasm symptoms.
Relaxation techniques, including controlled breathing, may be a recommended home treatment for cricopharyngeal spasms.
Coping techniques for cricopharyngeal spasms, such as relaxation or distracting oneself during spasms, may be enough to make them less uncomfortable, even unnoticeable.
Options of home treatments for cricopharyngeal spasms include:
- relaxation techniques, including controlled breathing, meditation, guided thought, and visualization
- over-the-counter muscle relaxants
- heated bags or pads, as well as warm drinks or foods
- eating and drinking foods, slowly, to prolong the absence of symptoms
- gently massage of the throat and neck
- gentle neck-stretching exercises
- tucking in the chin or rotating the neck slowly
- moderate exercise
- herbal remedies that promote relaxation and relieve discomfort, including chamomile, peppermint, ginseng, and lemon balm teas
- menthol applied to the throat or affected part of the neck for a numbing, cooling sensation
- tracking and avoiding factors that worsen symptoms
- avoiding stressful situations while experiencing spasms or until they have passed
- avoiding irritants or allergens that may cause the throat to swell and feel more constricted, especially airborne or consumed ones
Once cricopharyngeal spasms are diagnosed, people become less anxious about the symptoms and tend to notice the spasms less.
The best treatment depends on the cause and extent of a person's symptoms.
In some cases, cricopharyngeal spasms can be caused by neurological conditions or damaging events, such as a stroke, or they can occur because of cricopharyngeal dysfunction.
When associated with cricopharyngeal dysfunction, muscle spasms may cause dysphagia or difficulty swallowing.
An estimated 5.2 percent of people who experience serious strokes, experience some form of cricopharyngeal dysfunction. Roughly 5.7 percent of people with neurologically-based dysphagia have cricopharyngeal dysfunction.
Inflammation can also cause the esophageal and surrounding muscles to swell, leading to a feeling of restriction in the throat.
Treatment options for more severe or disabling cases of cricopharyngeal spasms include:
- botulinum A toxin (Botox) injections
- prescription muscle relaxants
- anti-reflux medications
- physical therapy
- psychological counseling
Medical therapy may be necessary for cricopharyngeal spasms that have a known cause, last for more than six months, or are painful, disabling, or cause severe anxiety.
What are the symptoms?
Common symptoms of cricopharyngeal spasms may include the feeling of a lump in the throat, a choking feeling, and a swollen neck.
The severity of symptoms of cricopharyngeal spasms depends on how contracted the muscle is. Some people may also be more sensitive, or aware, of the spasms. As the condition can cause a choking or gagging feeling, the spasms often cause anxiety, especially when they have been diagnosed.
The characteristic that distinguishes cricopharyngeal spasms from other similar conditions is that swallowing is usually not impaired. This is despite a persistent or continuous feeling of restriction.
Common symptoms include:
- The feeling of a lump, similar to a ping-pong ball stuck in the throat, that cannot be cleared or coughed out, known as Globus pharynges.
- A feeling of mucous being stuck in the throat that cannot be coughed up or swallowed.
- A choking feeling in a person's throat.
- Having the feeling of being strangled.
- A swollen neck.
- Feeling as if something is pushing or applying pressure to the space below the Adam's apple.
- Symptoms that normally reduce or go away when a person is eating and drinking.
- Symptoms that worsen with stress or exposure to allergens and irritants.
Unlike cricopharyngeal spasm, serious medical conditions, specifically cancer, do not cause noticeable symptoms in the throat until an individual can no longer eat and drink normally.
In rare instances, when there is a definitive cause of cricopharyngeal spasms and symptoms are disabling, last more than 6 months, or cause difficulty swallowing, surgery may be necessary.
In cricopharyngeal myotomy, a surgeon makes small cuts across the cricopharyngeal muscle to reduce its ability to contract. The procedure is typically done using an endoscope, which consists of a flexible tube with a camera and light attached, and a laser to make the cuts.
An estimated 50 to 70 percent of those who undergo the procedure report an improved ability to swallow.
Stress and anxiety may increase or cause cricopharyngeal spasms.
The full range of contributing factors that influence the development of cricopharyngeal spasms is still unknown.
Anxiety and stress are thought to increase greatly and even, potentially, cause the spasms.
Reducing stress, and engaging in stress-releasing activities, such as exercise, deep breathing, and mediation, may reduce the risk of cricopharyngeal spasms.
When directly related to neurological, acid reflux, or inflammatory conditions, treating the underlying cause with management medications usually stops spasms and reduces the risk of their recurrence.
Cricopharyngeal spasms tend to resolve on their own or with stress and anxiety management.
The condition tends to last a few days, weeks, or months, often depending on how a person responds to the spasms and their level of engagement with management techniques.
People who become very anxious or stressed by the spasms, or decide actively to try and manage the symptoms, tend to experience more severe symptoms for longer.