Cricopharyngeal Muscle Dysfunction

The cricopharyngeal muscle (CPM) is found between the esophagus (the tube bringing food and drink from your mouth to your stomach) and your throat. It supports the upper esophageal sphincter in controlling the opening of the esophagus, preventing air from inadvertently entering this tube when not eating and drinking. The CPM also functions to protect the trachea (windpipe) and lungs from any regurgitated stomach contents. Dysfunction of this muscle results in an inability to swallow food, drink, medications, and even your own saliva.

Causes of Cricopharyngeal Muscle Dysfunction

Impairment of the CPM means the upper esophageal sphincter is unable to open properly, resulting in a type of dysphagia, the medical term for swallowing disorders. Although CPM dysfunction is not considered a normal or expected aspect of aging, it is more common in older adults. CPM dysfunction may be a result of:

• Changes to nerve signaling pathways controlling the CPM
• Scarring of the CPM due to trauma, surgery, or radiation
• Stroke resulting in damage to areas of the brain controlling the nerves to the CPM and upper esophageal sphincter
• Hypertrophy (enlargement) of the CPM, typically due to conditions such as gastroesophageal reflux, Zenker’s diverticulum, or muscle weakness

CPM dysfunction and dysphagia can also be present with no identifiable cause, a situation known as idiopathic cricopharyngeal dysfunction.

Symptoms of Cricopharyngeal Dysfunction

Because dysfunction of CPM affects normal swallowing, over time it may cause affected individuals to develop a fear of eating and drinking. In addition to difficulty swallowing, other symptoms can include:

• Pain on swallowing
• The sensation of food getting stuck at the back of the throat
• Coughing and choking when ingesting solids or liquids
• Changes to the voice, such as a “wet” quality to speech
• Aspiration pneumonia from accidentally inhaling food or drink into the lungs

Though less common than adults, children can also be affected by CPM dysfunction. The symptoms of this condition in a child are similar to those of an adult but may also include nasal congestion and a blue tinge to the skin known as cyanosis.

Diagnosis and Treatment of Cricopharyngeal Dysfunction

Dysphagia and suspected CPM dysfunction is managed by an ENT (ear, nose, throat) specialist. Diagnosis can be made through a physical exam of the throat and voice box with an endoscope (a thin, flexible tube passed through the nose), as well as an x-ray swallow test. This test involves swallowing edible items which have been coated in a substance called barium. The barium shows brightly on an x-ray scan, allowing the doctor to examine the function of the esophagus while you’re swallowing. The ENT specialist may also order a manometry test, which assesses muscle coordination and pressure in the throat and esophagus during a swallowing motion. If CPM dysfunction is present, the esophageal valve may demonstrate unusually elevated pressures.

There are several treatment options for managing cricopharyngeal muscle dysfunction, which tend to come with good success. Depending on the underlying cause of your CPM dysfunction, your ENT specialist may recommend:

• Botox injections to aid the upper esophageal sphincter in relaxing. These applications of botulinum toxin need to be repeated every 3 to 6 months
• Surgical stretching of the esophagus through a process known as dilatation. During this procedure, a balloon catheter is inserted into the esophagus under general anesthesia. As the balloon is inflated, this expands and loosens the esophagus and CPM, allowing ingested food and drink to pass through more easily. Eventually, the effects of dilatation will wear off and need to be repeated.
• Myotomy, which aims to release the tension of the cricopharyngeal muscle by creating an incision, whether with a surgical blade or a carbon dioxide laser

Depending on your situation, your ENT doctor may also suggest alleviating symptoms using certain exercises to improve muscle coordination or preparing your food and drink in a specific way to enable easier swallowing.

As dysphagia from cricopharyngeal muscle dysfunction can cause choking and pain on swallowing, many patients feel anxious or fearful of eating and drinking, leading to unhealthy weight loss and malnutrition. However, CPM dysfunction can typically be successfully treated under the care of an ENT specialist, significantly improving quality of life.