Cricopharyngeal Spasm

Overview

What is cricopharyngeal spasm?

The cricopharyngeal muscle — sometimes called the upper esophageal sphincter (UES) — is located at the top portion of your esophagus (food pipe). This muscle contracts to open and close the esophagus, allowing food and liquid to pass through. In people with cricopharyngeal spasm, this muscle contracts too much. When this happens, you can still swallow but your throat feels uncomfortable.

What does a cricopharyngeal spasm feel like?

People with cricopharyngeal spasm describe feeling as though a large object is stuck in their throat. This can be accompanied by choking or tightening sensations. Cricopharyngeal spasm pain is usually worse between meals. Symptoms tend to disappear while you’re eating or drinking.

Who does cricopharyngeal spasm affect?

Cricopharyngeal spasm can affect people of all ages, even children. The condition may be related to other health issues, such as acid reflux, inflammatory problems or neurological issues. It’s estimated that over 5% of people who have serious strokes will develop cricopharyngeal spasm to some degree.

Symptoms and Causes

What causes cricopharyngeal spasm?

Experts still don’t understand the full range of cricopharyngeal spasm causes. But the primary known factors include:

  • Cricopharyngeal dysfunction.
  • Neurological issues, such as stroke.
  • Acid reflux or GERD.
  • Inflammatory conditions.

What are the symptoms of cricopharyngeal spasm?

Cricopharyngeal symptoms can range from mild to severe. They may include:

  • A choking or strangling sensation.
  • Feeling as though there’s a lump in your throat that can’t be cleared.
  • Pressure on the area just below your Adam’s apple.
  • A swollen neck.

Can anxiety cause throat spasms?

Yes. Anxiety can cause a number of physical symptoms — and throat tightness is one of the most common. People with cricopharyngeal spasm may have flare-ups during times of stress.

The symptoms above usually go away when you’re eating or drinking. They can also worsen when you’re stressed. Even though many people with cricopharyngeal spasm feel restriction in their throat, they can still swallow normally. In contrast, people with other, similar conditions may develop dysphagia (difficulty swallowing).

Diagnosis and Tests

How is cricopharyngeal spasm diagnosed?

Your healthcare provider will perform an assessment and talk with you about your symptoms. They’ll check the back of your throat for something called an esophageal diverticulum. This is a pocket that forms in the esophageal lining. It can develop if cricopharyngeal spasm goes untreated for a long time. Food and saliva can collect in this pouch.

Your medical team may also run some tests to confirm your diagnosis. These may include:

  • GI X-ray examinations: You’ll be asked to drink a barium liquid that coats your digestive tract. X-rays are then taken so that your esophagus can be examined.
  • Esophageal manometry test: This test shows how the muscles in your esophagus operate when you swallow.
  • Upper endoscopy procedure: A thin tube with a camera at the end is inserted down your throat. This allows your healthcare provider to examine your esophagus in greater detail.

Management and Treatment

How is cricopharyngeal spasm treated?

Management depends on the cause and severity of your symptoms. Cricopharyngeal spasm treatments include:

  • Botox injections: This treatment temporarily weakens the affected muscles, helping them relax.
  • Muscle relaxants: Valium or other types of prescription muscle relaxants can help calm stress that triggers cricopharyngeal spasm.
  • Medications for reflux and GERD: If cricopharyngeal spasm is related to acid reflux, GERD or similar conditions, your healthcare provider may prescribe anti-reflux medications.
  • Physical therapy: Exercises for cricopharyngeal spasm can help ease your symptoms. A physical therapist can show you how to relax the affected muscles.
  • Counseling: If stress is a contributing factor, counseling can help. Managing your anxiety can reduce — and in some cases eliminate — cricopharyngeal spasm symptoms.

In very rare instances, surgery may be necessary. During this procedure, your surgeon makes cuts in the cricopharyngeal muscle so it doesn’t contract too much.

How can I manage cricopharyngeal spasm symptoms?

In addition to medical treatments, there are also ways to manage cricopharyngeal spasm symptoms at home. For example:

  • Practice mindfulness, meditation or other relaxation techniques.
  • Drink warm beverages to help relax your throat muscles.
  • Eat smaller meals throughout the day. This helps the throat muscles stay relaxed for longer.
  • Gently massage your neck and throat.
  • Take supplements to reduce cricopharyngeal spasm. Magnesium may be particularly helpful.
  • Keep track of factors that make your symptoms worse — then avoid them.

How soon after treatment will I feel better?

In most cases, people with cricopharyngeal spasm notice improvement in about three weeks. Everyone is unique, however, and this timeline can vary for each person.

Sometimes, just being aware of the problem is helpful. Once cricopharyngeal spasm is diagnosed, people may become less anxious and experience symptoms less often.

Prevention

How can I prevent cricopharyngeal spasm?

Cricopharyngeal spasm can’t always be prevented. But treating the underlying cause — such as acid reflux, neurological issues or inflammatory conditions — can help reduce your risk. Additionally, managing stress and anxiety can be instrumental in easing your symptoms.

Outlook / Prognosis

What can I expect if I have cricopharyngeal spasm?

Most of the time, cricopharyngeal spasms go away on their own. You may experience flare-ups during times of stress, but learning to manage your symptoms can help improve your quality of life.

Living With

When should I see my healthcare provider?

If you’ve had symptoms lasting longer than three weeks, schedule a consultation with your healthcare provider. They may run some tests to rule out other, more serious conditions.

Frequently Asked Questions

Why do I feel my throat twitching?

It could mean that your cricopharyngeal muscle is contracting. Throat twitches may also be related to esophageal spasms, acid reflux or other conditions.

How does the cricopharyngeal muscle relax?

Swallowing helps to relax the cricopharyngeal muscle. This is why eating and drinking seems to temporarily ease symptoms. You can also try these exercises for cricopharyngeal spasm:

  • Shaker exercise: Lay down, raise your head and look at your feet without lifting your shoulders. Hold for 60 seconds, then repeat a few times.
  • Mendelsohn maneuver: Hold your voice box for three to five seconds after swallowing.

Be sure to talk to your healthcare provider before incorporating any exercises into your daily routine.

A note from Cleveland Clinic

Cricopharyngeal spasms are usually not a serious medical concern. However, they can be quite uncomfortable. Learning relaxation techniques and physical therapy exercises can help reduce your symptoms. If your symptoms persist, schedule an appointment with an ear, nose and throat specialist. They can determine the root cause of your condition and recommend a personalized treatment plan.

Last reviewed by a Cleveland Clinic medical professional on 09/07/2021.

References

  • American Academy of Otolaryngology-Head and Neck Surgery. Cricopharyngeal Muscle Dysfunction. (https://www.enthealth.org/conditions/cricopharyngeal-muscle-dysfunction/) Accessed 9/20/2021.
  • Jeong SH, Kim YJ, Kim YJ, Park KD, Kim EJ. Endoscopic botulinum toxin injection for treatment of pharyngeal dysphagia in patients with cricopharyngeal dysfunction. (https://pubmed.ncbi.nlm.nih.gov/30353754/) Scandinavian Journal of Gastroenterology. 2018 Oct-Nov;53(10-11):1201-1205. doi: 10.1080/00365521.2018.1506820. Epub 2018 Oct 24. PMID: 30353754. Accessed 9/20/2021.
  • National Institute of Mental Health. Anxiety Disorders. (https://www.nimh.nih.gov/health/topics/anxiety-disorders/) Accessed 9/20/2021.
  • Parameswaran MS, Soliman AM. Endoscopic botulinum toxin injection for cricopharyngeal dysphagia. (https://pubmed.ncbi.nlm.nih.gov/12389853/) Annals of Otology, Rhinology & Laryngology. 2002 Oct;111(10):871-4. doi: 10.1177/000348940211101002. PMID: 12389853. Accessed 9/20/2021.
  • Williamson A, Scholfield D, Awad Z. Swallowing Outcomes in 7 Patients Following Endoscopic Cricopharyngeal Myotomy With Primary Closure. (https://pubmed.ncbi.nlm.nih.gov/32970491/) Ear, Nose & Throat Journal. 2020 Sep 24:145561320959569. doi: 10.1177/0145561320959569. Epub ahead of print. PMID: 32970491. Accessed 9/20/2021.

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