cricopharyngeal spasm

Written by Dr.Bayat
Associate Professor of Orthopedic expert,Brigham Hostpital

Are you Expericieing  cricopharyngeal spasm? Does your throat feel like hurting? Are you having problem in swallowing? Do you want to know more about keep reading. In this article you will find everything related to it.

Cricopharyngeal spasms can be caused by as simple as by anxiety stress or psychological disorders to as complicated as by vocal cord tumours. There are other causes as well like GERD, trauma radiation etc.


Cricopharyngeal Spasm

A cricopharyngeal spasm is that type of muscle spasm that occurs in the throat. Also known as the upper esophageal sphincter (UES), the cricopharyngeal muscle is situated at the top part of the esophagus. As part of the digestive system, the esophagus helps in digestion of food and prevents acid from going up from the stomach.

It’s totally normal  for cricopharyngeal muscle to contract. In fact, this is what helps the esophagus moderate food and liquid intake in human body. A spasm occurs with this muscle when it contracts way too much. This is called  hypercontraction state. While one can still swallow drinks and food items, the spasms can make throat feel very uncomfortable.


What are the symptoms of  cricopharyngeal spasms?

With cricopharyngeal spasm, one can still  eat and drink. Discomfort have tendency to be highest in between beverages and meals.

Symptoms can include following:

The symptoms of  cricopharyngeal spasm disappear while eating foods or liquids. This is due to  relaxation of related muscles that help in eating  and drinking. Moreover, symptoms of the cricopharyngeal spasm tend to get worse throughout the day. Anxiety about this  condition can also aggravate symptoms. Cricopharyngeal spasm occurs because the sphincter does not open properly as a result of incoordination or weakness in the muscles that surround it. This can occur due to a number of reasons, few of them are listed below:


What are Causes of cricopharyngeal spasm?

  • Anxiety and psychological issue:

Cricopharyngeal spasm or globus can often be experienced by individuals at times of stress or anxiety. It Usually occurs while holding back strong feelings or emotions. The mechanism is not that known yet how but it does.

  • Acid Reflux:

Acid reflux, also referred to as ‘silent reflux’ is a condition where the stomach acids travel up the food pipe and into the throat. It can be difficult to detect sometimes as individuals often do not get the symptoms of heartburn or indigestion, but it is usually associated with chronic throat clearing, voice change and globus sensation.

  • Due to thyroid gland:

Thyroid Nodules greater than 3 cm and those located anterior to the trachea have a tendency to cause cricopharyngeal symptoms. In horizontal location, nodules that are located anterior to the trachea show a higher tendency to cause globus symptoms than nodules that are  located anterior to the trachea. In short, thyroid nodules with specific size and location can cause globus symptoms, and this finding can be helpful in diagnosis.

  • Voice box tumour:

Symptoms of vocal cord tumour are feeling Lump in the neck or throat, Dysphonia, trouble making voice sounds even ear pain. Other symptoms may include dyspnea Globus sensation, feeling that something’s in your throat and hemoptysis

  • Nerve signalling pathway changes:

The nerve signalling pathways which  tell the CPM when to relax and when to contract can change, causing cricopharyngeal dysfunction which leads to spasms.

  • Trauma, surgery, or radiation:

Any process that causes scarring of this area can lead to immediate or even delayed cricopharyngeal dysfunction like cricopharyngeal spasm can occur years after surgery.

  • Radiation therapy:

It may cause scarring of the CPM as well, which can result in cricopharyngeal spasm in later years.

  • Stroke:

Stroke can cause serious brain damage that also impairs the ability to use the nerves controlling the upper esophageal sphincter. Mostly people who have had an acute stroke also develop cricopharyngeal spasm.

  • Enlarged CPM:

Cricopharyngeal spasm may also occur in people if they have an enlarged, or prominent, CPM. This may be the result of the following things :

muscle weakness

Zenker’s diverticulum, which is when a balloon of tissue happens in the wall of the throat.

Few esophageal diseases, such as gastroesophageal reflux disease and esophageal spasm

  • No known cause:

Sometimes, the condition may occur on its own without any  reason. Its caller idiopathic cricopharyngeal spasm or dysfunction.

Additionally, stress can also worsen symptoms in people with the cricopharyngeal dysfunction.


 How to treat cricopharyngeal spasms?

These types of spasms can be cured with simple home remedies. Changes in eating habits are perhaps the most promising solution. By eating and drinking small amounts throughout the day, UES may be in a more relaxed state for longer which will make it feel better . This is compared with eating couple of large meals all the day. Drinking an occasional glass of warm water may have quite same effects.

Stress over UES spasms can also increase  symptoms, so it’s important to relax as much as possible. Some Breathing techniques, guided meditation, and other relaxing activities may help in this.

For persistent spasms, doctor may prescribe diazepam (Valium) or any other type of muscle relaxant. Valium is used to treat anxiety, but it may also be helpful in calming stress related to throat spasms when taken temporarily in some cases. It’s also sometimes used to treat tremors and in few cases for musculoskeletal injuries. Xanax, an anti-anxiety drug,  also  may alleviate symptoms sometimes.

In addition to home remedies and medication  a visit to physical therapist may be needed . They  help in learning neck exercises to relax hypercontraction’s.

In very less and rare instances, when there is a definitive cause of cricopharyngeal spasms and symptoms are disabling which last more than 6 months, or cause difficulty swallowing, surgery is needed. In cricopharyngeal myotomy, a surgeon makes small cuts across the cricopharyngeal muscle to reduce its ability to contract which will help it to be in relaxed form for more time. This procedure is typically done using an endoscope, which consists of a flexible tube like thing with a camera and light attached, also laser to make the cuts


How to diagnosis cricopharyngeal spasms?

The cricopharyngeal spasms occur in the cricopharyngeal part of the inferior pharyngeal constrictor muscle, at the bottom of throat. They cause severe muscle tension on the cricoid cartilage, leading to a Globus feeling. Pharyngeal spasms, another more common source of a Globus feeling, instead cause tension on the thyroid cartilage. According to studies, the symptoms of cricopharyngeal spasm tend to resolve on their own after around two three weeks. In some cases, symptoms may last longer. A visit to doctor is needed to rule out other possible causes of throat spasm to make sure it ain't any serious condition. These spasms are frequently misunderstood by the patient with a cancer due to the that 'lump in the throat' feeling .

All the anatomic examinations may appear normal despite having this condition. The throat endoscopy can clear that nothing is stuck, that there is no lesion or any other inflammation. The barium swallow can even miss that the sphincter is hypertonic if it does not occur during the examination, or if the sphincter still relaxes enough for the food bolus to pass through.

The esophageal Manometry cannot detect any abnormal wave present despite discomfort.


Complications and associated conditions with cricopharyngeal spasms

 If one experiences other symptoms, like swallowing difficulties or chest pain,  it might be an associated condition. Possibilities include following:

  • dysphagia
  • heartburn
  • gastroesophageal reflux disease
  • esophageal damage which can be caused by persistent heartburn
  • Different types of esophageal strictures caused by swelling, like noncancerous growths.
  • Some neurological disorders, such as Parkinson’s disease.
  • brain damage from  injuries or stroke.

To rule out all these conditions, doctor may order some types of esophageal tests:

  • Motility tests : tests that measure the overall strength and movement of muscles.
  • Endoscopy: A procedure in which a small light and camera are placed in esophagus so that doctor can have a better look at the area.
  • Manometry: This helps with the measurement of esophageal pressure waves.


Home treatments for cricopharyngeal spasms include following:

  • Relaxation techniques, including breathing, meditation, guided thought, and even visualization.
  • Over-the-counter muscle relaxants.
  • Heated bags and warm drinks or foods
  • Eating and drinking food slowly, to help in prolong the absence of symptoms
  • Gentle massage of the throat and neck
  • Gentle neck-stretching exercises that can help like rotating the neck Slowly
  • Herbal remedies that can promote relaxation and can help in relieving discomfort, including chamomile, peppermint, ginseng, and lemon balm teas.
  • Menthol can be 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 as much as possible while experiencing spasms or until they pass.
  • Try avoiding irritants or allergens that may cause the throat to swell and feel more congested, especially airborne or consumed ones.
  • Once cricopharyngeal spasms are properly diagnosed, people become less anxious about it about the symptoms also become less and they tend to notice the spasms less.


How to prevent cricopharyngeal spasms?

The  contributing factors that influence the development of cricopharyngeal spasms are still unknown.

  • Anxiety and stress are mostly thought to increase greatly and potentially, cause the spasms.
  • Reducing stress, and engaging in many stress-releasing activities, such as exercise, deep breathing, and mediation, may help in reducing the risk of cricopharyngeal spasms.
  • When directly related to neurological, acid reflux, or inflammatory conditions, treating the underlying cause with proper management and medications usually stops spasms and reduces the risk of their recurrence greatly.


Outlook for cricopharyngeal spasms

Overall, this condition i.e. cricopharyngeal spasm isn’t a significant medical concern. It may cause some throat discomfort during periods when  esophagus is in a relaxed state, such as between the meals. However, if persistent discomfort is present due to these spasms a doctor may be addressed. If the discomfort still persists even while drinking and eating, the symptoms are likely to be related to another cause not the spasms.

A specialist should see be consulted  for a proper diagnosis. Cricopharyngeal spasms remain a rare symptom until today . Difficulties for the patient to describe an unusual symptom and to figure out the condition  for doctors can entail a prompt diagnosis.


Written by Dr.Bayat
Associate Professor of Orthopedic expert,Brigham Hostpital



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