Cricopharyngeal Dysfunction

Overview

Cricopharyngeal dysfunction is a swallowing disorder involving the cricopharyngeus muscle, which forms the upper esophageal sphincter at the top of the esophagus. Normally this muscle relaxes at just the right moment to let food and liquid pass from the throat into the esophagus, then tightens to prevent backflow. In this condition, the muscle does not relax properly or is poorly coordinated, so swallowed material has difficulty getting through.

The result is a sensation of food sticking in the throat and trouble swallowing (dysphagia). It can occur on its own or alongside neurological conditions or aging. Because difficulty swallowing can lead to choking, weight loss, or food entering the airway, evaluation and treatment are important.

Symptoms

Symptoms center on difficulty moving food from the throat into the esophagus. They include:

• A feeling that food sticks in the throat or upper neck
• Difficulty swallowing, especially solid foods
• The need to swallow repeatedly to clear food
• Coughing or choking during meals
• Bringing food back up into the mouth (regurgitation)
• A gurgling sound or, in some cases, a bulge in the neck if a pouch (diverticulum) forms

Frequent coughing or choking while eating can lead to food or liquid entering the lungs (aspiration), which raises the risk of pneumonia and requires prompt attention.

Causes

Cricopharyngeal dysfunction can have several underlying causes:

• Muscle abnormalities: The cricopharyngeus muscle becomes stiff, scarred, or fails to relax and coordinate properly.
• Neurological conditions: Stroke, Parkinson disease, and other nerve or muscle disorders can impair the timing of the swallow.
• Aging: Changes in muscle and nerve function can affect swallowing in older adults.
• Acid reflux: Long-standing irritation may contribute in some people.

In some cases, the dysfunction contributes to the formation of a throat pouch called a Zenker diverticulum.

Risk Factors

• Older age
• Neurological conditions such as stroke or Parkinson disease
• Muscle disorders affecting the throat
• Prior radiation or surgery to the neck
• Chronic acid reflux

Diagnosis

Diagnosis usually involves a swallowing study. A modified barium swallow (videofluoroscopy) records X-ray video as a person swallows barium-coated food and liquid, showing how the upper esophageal muscle is working.

Other tests may include an esophagram (barium swallow X-ray), endoscopy to look directly at the throat and esophagus, and sometimes pressure measurements of the swallowing muscles (manometry). An evaluation by a speech-language pathologist often helps assess swallowing safety, and underlying neurological causes may be investigated.

Treatment

Treatment depends on the cause and severity:

• Swallowing therapy: A speech-language pathologist can teach techniques and exercises to swallow more safely and effectively.
• Dietary changes: Adjusting food textures and liquid thickness to reduce choking risk.
• Botulinum toxin injection: Injected into the cricopharyngeus muscle to help it relax, in selected cases.
• Cricopharyngeal myotomy: A surgical procedure that cuts the tight muscle to ease passage of food; it can be done through the mouth (endoscopically) or through the neck.
• Dilation: Stretching the area in some cases.

Treating any underlying neurological condition is also important.

When to See a Doctor

See a doctor if you have ongoing trouble swallowing, a sensation of food sticking in your throat, frequent coughing or choking with meals, or unexplained weight loss. Persistent difficulty swallowing should always be evaluated, as it can have several causes.

Seek emergency care if food becomes completely stuck and you cannot swallow your own saliva, or if you choke and cannot breathe. Recurrent choking that leads to coughing, fever, and shortness of breath after meals may signal food entering the lungs and needs prompt medical attention.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Swallowing difficulty.
2. American Speech-Language-Hearing Association (ASHA).
3. National Institute on Deafness and Other Communication Disorders (NIDCD).
4. Cleveland Clinic. Dysphagia.