What is Cricopharyngeal Dysfunction: Causes, Symptoms, Treatment

Cricopharyngeal Dysfunction is an extremely rare disorder of the upper esophageal sphincter. It is characterized by difficulty swallowing, aspiration, and narrowing around the upper esophageal sphincter. Cricopharyngeal Dysfunction affects the muscle located at the top of the throat. This muscle is called the Cricopharyngeal Muscle. The upper esophageal sphincter is a valve present right at the start of the esophagus. This valve opens up when a person swallows food or drink.^[1,2,3]

In Cricopharyngeal Dysfunction this valve does not open up the way it should causing problems with swallowing. As stated, it is very rare for this valve to dysfunction. The treatment for Cricopharyngeal Dysfunction involves Botox injections, exercises, and even surgery.^[1,2,3]

Cricopharyngeal Dysfunction is a functional disorder. It can happen when the muscles supporting the sphincter become weak or there is no sync between these muscles. This can happen due to a variety of reasons including.^[3]

Changes in Nerve Signal Pathway: Sometimes the nerve pathways that instruct the Cricopharyngeal Muscle as to when to open and close undergoes some changes as a result of which Cricopharyngeal Dysfunction may occur.^[3]

Trauma: Cricopharyngeal Dysfunction may also be caused due to trauma to the Cricopharyngeal Muscle. This can happen in several ways. A surgery around the throat, radiation therapy to treat cancer around the throat or a direct injury like a gunshot wound all can cause Cricopharyngeal Dysfunction.^[3]

A study done in 2020 mentions that Cricopharyngeal Dysfunction can occur years after the original injury or trauma. Radiation causes scarring of the Cricopharyngeal Muscle. The scarring can result in Cricopharyngeal Dysfunction.^[3]

Stroke: This is yet another probable cause for Cricopharyngeal Dysfunction. This is because when a person has a stroke, there is significant brain damage and the nerve may not be able to send proper signals to the upper esophageal sphincter to open and close causing Cricopharyngeal Dysfunction. Based on a study done in 2016, about 5% of people with a history of stroke develop Cricopharyngeal Dysfunction later on.^[3]

Enlarged Cricopharyngeal Muscle: Sometimes, conditions like Zenker Diverticulum, GERD, or muscle weakness all can cause an enlargement of the Cricopharyngeal Muscle resulting in Cricopharyngeal Dysfunction.^[3]

There are many cases where the root cause of Cricopharyngeal Dysfunction is not identified. This is called as idiopathic Cricopharyngeal Dysfunction. It has also been observed that increased stress also has a role to play in worsening of the symptoms of Cricopharyngeal Dysfunction.^[3]

The function of the Cricopharyngeal Muscle is to prevent air from entering the esophagus when a person is not eating or drinking. It also prevents food from refluxing back to the mouth or entering other parts of the body like the lungs. Cricopharyngeal Dysfunction is seen mostly in elderly population even though children may also get it.^[3]

Some of the symptoms that an adult with Cricopharyngeal Dysfunction will experience include a sensation that something is stuck inside the throat. The person will also have difficulty swallowing or pain when swallowing either solids or liquids. They may also have choking episodes when eating. Some people notice a considerable change in their voice as a result of Cricopharyngeal Dysfunction. Due to these symptoms, a person with Cricopharyngeal Dysfunction will start to feel scared just at the thought of eating food.^[3]

In cases of children with Cricopharyngeal Dysfunction, the symptoms are quite common to that of the adults including painful and difficulty swallowing and choking.

However, children will have additional symptoms of recurrent pneumonia and nasal congestion. Some children also develop cyanosis as a result of Cricopharyngeal Dysfunction.^[3]

The treatment for Cricopharyngeal Dysfunction is determined by the underlying cause. However, there are different ways to calm down the symptoms of this condition.

There are certain exercises that a person can do to ease the symptoms of Cricopharyngeal Dysfunction. The first exercise is called the Shaker Exercise which involves lying down and lifting the head up to look at the feet without lifting the shoulder. The person has to maintain this posture for about a minute. This can help ease the symptoms.^[3]

The second exercise is called the Mendelsohn maneuver. This exercise involves holding the voice box for about 5 seconds during swallowing. It makes swallowing more comfortable. A person can also ease the symptoms of Cricopharyngeal Dysfunction by changing the texture of the food. He or she can make liquid hard by adding some powder in it or make hard foods soft.^[3]

Another treatment that is believed to be effective for Cricopharyngeal Dysfunction is the use of Botox injections. This treatment relaxes the upper esophageal sphincter and allows the person to swallow food comfortably. However, this treatment will have to be repeated every six months for continued relief. It should be noted here that not all people with Cricopharyngeal Dysfunction benefit from this treatment.^[3]

Surgery: This is the most effective way to treat Cricopharyngeal Dysfunction. There are numerous surgical options available for this and include

Dilatation: This procedure involves stretching the esophagus by way of the balloon catheter which is inserted in the esophagus and is inflated. The stretching of the esophagus increases its size and loosens up the Cricopharyngeal Muscle. This allows the person to swallow food and liquids easily.^[3]

The procedure is done under general anesthesia. A study done in 2015 revealed that this procedure is effective up to six months after surgery. However, this procedure will have to be repeated as this is not a permanent solution.^[3]

Cricopharyngeus Muscle Myotomy: This is yet another surgical procedure which has been shown to be effective in treating Cricopharyngeal Dysfunction. It involves cutting the Cricopharyngeal Muscle such that it becomes loose and allows the person to swallow comfortably.^[3]

There are basically two ways to achieve the goal of easing out the symptoms of Cricopharyngeal Dysfunction. The first is called the endoscopic cricopharyngeal myotomy. This procedure involves use of carbon dioxide laser to cut through the Cricopharyngeal Muscle and improve the symptoms of Cricopharyngeal Dysfunction. As the laser cuts through the muscle, it becomes loose and allows food to pass through it easily. This is a minimally invasive procedure.^[3]

The second procedure is called stapling. This is more preferred for people with Cricopharyngeal Dysfunction due to Zenker Diverticulum. It is the least invasive procedure. A study done in 2015 comparing the two procedures for treatment of Cricopharyngeal Dysfunction revealed that laser surgery was far more effective in curtailing the symptoms of Cricopharyngeal Dysfunction. Studies have revealed that laser surgery has been far more effective than the stapling procedure for the treatment of Cricopharyngeal Dysfunction.^[3]

In conclusion, Cricopharyngeal Dysfunction is a rare functional disorder of the upper esophageal sphincter. It is characterized by difficulty and painful swallowing and a feeling that something is stuck in the throat. The symptoms can be so severe that a person with this condition may become fearful of eating or drinking anything. This can have significant impact on the overall health of the person.^[1,2,3]

There are numerous causes for Cricopharyngeal Dysfunction including a trauma, radiation, or surgery around the throat. A change in nerve signal pathways can also cause Cricopharyngeal Dysfunction. Some people with a history of stroke also tend to have Cricopharyngeal Dysfunction.^[1,2,3]

Surgery is the most preferred treatment for Cricopharyngeal Dysfunction even though there are exercises and diet practices that can be followed to ease out the symptoms of Cricopharyngeal Dysfunction.^[1,2,3]

References: