Cricopharyngeal spasm is a self-limiting disorder caused by spasm of the cricopharyngeus muscle — the upper esophageal sphincter — producing a distinctive lump-in-the-throat sensation called globus pharyngeus. Despite feeling alarming, it resolves on its own and is not dangerous.
Symptoms
The symptoms are quite characteristic and almost diagnostic on their own:
- Sensation of a lump — described as a golf ball, tennis ball, or fur ball stuck in the throat
- Feeling that a collar or tie is too tight
- Sensation of being strangled or of throat swelling
- Symptoms are worst later in the day and best in the morning
- Stress reliably aggravates symptoms
- Saliva is difficult to swallow, yet food is easy to swallow
- Eating often makes the tightness go away temporarily
- The sensation can be reproduced by pressing on the cartilage just below the Adam’s apple
- Similar to the sensation of ‘getting choked up’ at an emotional moment
What Is the Cricopharyngeus Muscle?
The cricopharyngeus is a ring of muscle at the top of the esophagus that acts as a valve — relaxing to allow food and liquid to pass, then contracting to prevent backflow. Under stress or tension, this muscle can go into spasm and simply refuse to relax completely, producing the lump sensation.
Causes
Stress
Emotional stress is the most common trigger. Many patients notice the onset of symptoms during a particularly stressful period of life, and improvement when stress is reduced.
Postnasal Drip
Chronic mucus draining down the back of the throat can create the sensation of something being stuck, and can irritate the cricopharyngeal region.
Why Is Food Easy but Saliva Hard?
This is the key diagnostic clue. In true cricopharyngeal spasm, the act of swallowing food actually triggers normal relaxation of the muscle — relieving the spasm temporarily. Saliva pooling in the throat without the swallow trigger perpetuates the sensation. Structural obstruction (a tumor, for example) would cause difficulty with solids, not relief.
Management
Reassurance
Understanding that the condition is benign, self-limiting, and will resolve on its own is itself therapeutic. Anxiety about the symptom perpetuates the muscle tension.
Muscle Relaxation Techniques
Diaphragmatic breathing, neck stretching, and general stress management can reduce the baseline tension in the cricopharyngeus.
Medication
Although I do not manage the lump sensation long-term with medication, a brief treatment with a benzodiazepine (muscle relaxant) can be very convincing to the patient that the issue is muscle tightness.
When to Seek Further Evaluation
Although cricopharyngeal spasm is benign, any lump-in-the-throat sensation that is accompanied by progressive difficulty swallowing solids, weight loss, or a visible or palpable neck mass warrants prompt evaluation to exclude a structural or neoplastic cause.