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  • Cricopharyngeal spasm (difficulty swallowing)

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    Old 10-05-2003, 04:48 PM   #1
    lastoria
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    Post Cricopharyngeal spasm (difficulty swallowing)

    Here is some information about what is called a cricopharyngneal spasm. I am posting this here because I feel that myself and some others I have discussed this with might be experiencing this.

    -------------------------------
    Cricopharyngeal spasm
    Information for patients with a lump in the throat sensation
    Causes of a cricopharyngeal spasm
    Symptoms of a cricopharyngeal spasm
    Why did I get a cricopharyngeal spasm?
    A management program
    Benefits of managing cricopharyngeal spasm
    Causes
    This syndrome results from a spasm in the cricopharyngeus muscle. It is a self limiting disorder that will resolve on its own. The symptoms are so characteristic that as soon as a patient tells me they have a lump in the throat, I can usually describe all of their symptoms to them.
    Symptoms
    Lump in the throat sensation
    feels like a golf ball, tennis ball ... is stuck in my throat
    feels like my tie is too tight
    feel like I am being strangled
    my throat feels swollen
    The symptoms can be mimicked by pushing on the cartilage in the neck just below the Adams apple.
    The lump comes and goes depending on the day.
    Symptoms are usually best in the AM and worse later in the day
    Stress aggravates the symptoms.
    Saliva is difficult to swallow yet food is easy to swallow.
    Eating, in fact, often makes the tightness go away for a time.
    The symptoms are similar to getting choked up at a wedding or a funeral.
    Physiology 101
    There are two valves in the esophagus or swallowing tube. The are normally contracted and they relax when you swallow so that food can pass through them going to the stomach. They then squeeze closed again to prevent regurgitation of the stomach contents. If the normal contraction becomes a spasm, like a charlie horse of the calf muscle, these symptoms start. Stress often makes these spasms much worse. Many people have experienced neck tightness when stressed and this is similar. Even if not caused by stress, stress will make the spasm much worse.top

    A management program
    An exam of the neck and throat is extemely important to eliminate serious problems. In fact, it enters most peoples minds that a lump in the throat might be a cancer. In practice, real lumps in the throat, such as a cancer are not felt. It is one of the reasons that a cancer can get so big before it is discovered. It probably is fortunate that we don't have great sensation in the throat as we would then feel every particle of food, with every meal as it travels down the throat. So lacking great sensation in the throat, problems are a little mysterious there.

    Unfortunately, many physicians are not familiar with how symptomatic a cricopharyngeal spasm can be and I often see patients who have been extensively tested with Barium swallows, esophageal endoscopies, pH testing, CT scans, xrays, MRI scans and they all come back normal or possibly with some finding that is completely unrelated to the lump in the throat sensation. Really, just a good exam of the throat, voice box and neck is all that is necessary and it is sufficient as well. You should know the following:

    Just knowing the tightness is not a sign of cancer frequently helps relieve the discomfort.
    You will get better. Often improvement is over several weeks or even a few months, but occurs once one knows what the problem is.
    Warm fluids should comfort the throat. Consider a cup of warm tea when the lump is bothersome.
    If stress lets up, the symptoms improve. Think about what stress might be making this lump worse.
    Muscle relaxants, such as valium, would be a good treatment, except for their addictive properties.
    Medication
    I sometimes dispense several valium (perhaps 4) as a test to prove the symptoms are from muscle spasms. I recommend taking one of the Valium on a weekend, when being alert is not important. When the lump occurs, one takes the Valium. Within an hour, there should be significant improvement in the lump sensation. If the symptoms improve after taking the muscle relaxant, then the symptoms are reasonably from a muscle spasm. Again, the knowledge that a muscle relaxant makes a lump disappear can help confirm that the cause of the lump is from a muscle and not an actual lump.
    I have also tried injections with a local anesthetic, often with good, but temporary results. It does help to confirm in the patients mind, there is the possibility of relief.
    If a local anesthetic injections helps, I have with inconsistent results injected botulinum toxin into the cricopharyngeus muscle, sometimes with prolonged relief.


    Benefits
    The symptoms go away.

     
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    Old 10-05-2003, 06:27 PM   #2
    bassie
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    Thanks for that explanation. Having had the problem it still gave me extra info.

     
    Old 10-06-2003, 06:01 AM   #3
    DJblod
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    have you tried an acid suppressant eg lansoprazole as often these symptoms are due to acid reflux?

     
    Old 10-06-2003, 06:17 AM   #4
    lastoria
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    Actually I am on Aciphex (a proton pump inhibitor), which I've been on for about a month. I've had daily heartburn for the better part of a decade until I started that. Now I don't have heartburn at all anymore. Do you still think this problem could be predicated by GERD even though Aciphex seems to have elleviated my heartburn problems?

    Also, sometimes I get a mechanical clicking feeling on the left side of my throat. This is usually when I am dry swallowing a lot, or forcing a swallow.

    This is an audible click (at least I can hear it in my head) and it feels like cartilage "catching" in my throat.

    [This message has been edited by lastoria (edited 10-06-2003).]

     
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    Old 10-07-2003, 04:54 AM   #5
    DJblod
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    this symptom will be caused by reflux that doesn't cause any other symptoms eg acid taste, retrosternal discomfort. not familiar with that brand name as I'm British but are you on the higher dosage for that PPI?

     
    Old 10-07-2003, 04:56 AM   #6
    DJblod
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    also a month isn't necessary long enough. that clicking is probably unrelated - its probably the hyoid bone you're feeling

     
    Old 10-07-2003, 07:10 AM   #7
    lastoria
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    I think I'm on the standard dosage for Aciphex. I don't think it's a very popular brand, but it is a PPI. I'm on 20mg per day.

    I have an ENT appointment scheduled on 10/15, so hopefully I get some resolution then.

     
    Old 10-08-2003, 06:34 AM   #8
    lastoria
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    Quote:
    Originally posted by DJblod:
    also a month isn't necessary long enough. that clicking is probably unrelated - its probably the hyoid bone you're feeling
    What do you mean by unrelated? That clicking isn't normal is it? Or do you think it might be augmented from repeated swallowing? It's now starting to do this sometimes when I eat and drink.

    I have this fear that I have throat cancer. So I'm kind of obsessed with this problem at the moment. Sorry to be a pain.



     
    Old 10-08-2003, 08:36 AM   #9
    DJblod
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    everyone feels some clicking when swallowing - its the Eustachian tube being opened as you swallow

     
    Old 10-08-2003, 08:56 AM   #10
    lastoria
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    Ah, ok! Thanks for the information.

    I am continuing with the Aciphex PPI, and will talk with the ENT next week. Hopefully this will work itself out.

    Sometimes I feel that if the ENT convinces me it's not cancer I will be able to relax a bit and the problem will lighten up a bit.

     
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