Cricopharyngeal Spasm

Hyper-contraction of the cricopharyngeus muscle, which causes a constricted or lump-in-the-throat sensation. Cricopharyngeal spasm (CPS) is a harmless disorder, but it can cause great anxiety for somebody who is experiencing it and has not received a clear diagnosis for the symptoms.

The Physiology of Cricopharyngeal Spasm

The cricopharyngeus muscle, or upper esophageal sphincter, is a ring of muscle that encircles the upper end of the esophagus. This muscle is constantly contracted, closing off the entrance to the esophagus, except when a person swallows, at which point the muscle relaxes momentarily to let the food or liquid pass through.

In a person with cricopharyngeal spasm, the problem is that the cricopharyngeus muscle is overly contracted when in its state of habitual contraction. This hyper-contraction or hyper-tonic state may be felt by the person. However, the muscle will still relax properly during swallowing, and thus does not impede swallowing.

Symptoms of Cricopharyngeal Spasm

Individuals with cricopharyngeal spasm may describe a persistent sensation—usually felt precisely at the level of the cricoid cartilage—of something stuck in the throat, like a “wad of phlegm” or a “golf ball,” which the person cannot swallow or spit out. Or, similarly, they might say that they feel a sensation of choking or constriction in the throat. These kinds of symptoms may become worse as the day goes on, or in stressful situations.

However, a key indicator of cricopharyngeal spasm is that the person can still eat and drink without trouble, and that the troubling sensations described above actually tend to diminish or disappear when the person is eating. This happens because the cricopharyngeus muscle relaxes during swallowing (as it should), which temporarily relieves the hyper-contraction sensations. Very infrequent swallows of small amounts of saliva are not sufficient to be “therapy” for the hyper-contracted muscle, but swallowing one bite of food after another (as during a meal) is.

Treatment for Cricopharyngeal Spasm

For many patients with cricopharyngeal spasm, receiving a clear diagnosis is the start of the resolution of the problem. Once they understand the nature of their problem, and that it does not pose any risk to them, they can “throw their worry over the shoulder.” In many cases, the symptoms subsequently go away within a few weeks.

If the problem persists and continues to trouble the patient, a clinician might provide a few doses of valium, not as treatment, but so that each dose can serve as a diagnostic test to further prove the diagnosis to the patient, that it is a muscle-contraction issue. Also, if need be, some clinicians may try therapy such as neck relaxation exercises under the care of a speech pathologist or physical therapist.

Tracheal Stenosis Here Is A Red Herring; the Diagnosis Is Actually CPS

Tracheal stenosis? (1 of 4)

During a grave illness, this woman eventually underwent tracheotomy. Though she wore the tube for several months, it was removed 3 years ago. Only six months prior to this examination, due to a feeling of choking, she underwent a CT scan that revealed tracheal stenosis. The patient does have mildly noisy breathing but has no sense of exercise intolerance.

Narrowing at trachea (2 of 4)

Viewing from just below the vocal cords, there is narrowing and deformity of the trachea at the site of prior tracheotomy.

Closer view (3 of 4)

A closer view shows normal trachea beyond.

No significant change in breathing (4 of 4)

Now with the scope through the area of greatest narrowing, the patient doesn’t experience any significant change in her breathing. Her symptoms are those of cricopharyngeus spasm, not tracheal stenosis.