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Bone Disorders board


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.

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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.