Cricopharyngeal spasm

Information for patients with a lump in the throat sensation

Causes

This syndrome results from a spasm in the cricopharyngeus muscle. It is a self-limiting disorder that will resolve on its own.

Symptoms

  • Lump in the throat sensation
    • feels like a golf ball, tennis ball, fur 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 Adam's apple.
  • The lump comes and goes depending on the day.
  • Symptoms are usually best in the morning 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 funeral

Why did I get a cricopharyngeal spasm?

There are two valves in the esophagus or swallowing tube. They are normally lightly 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 Charley 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. Relaxation in many forms (from alcohol to meditation) may improve the symptoms.

Management program

An exam of the neck and throat is extemely important to eliminate serious problems. In fact, it enters most people's 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.

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, x-rays, MRI scans, and they all come back normal or possibly with some finding that is completely unrelated to the lump in the throat sensation. They may have been tried on numerous medications including proton pump inhibitors for presumed reflux.

Really, just a good exam of the throat, voice box and neck is all that is necessary and is sufficient, as well. I record my exam so I can play it back and show the patient the structures in the throat. If possible I may try to pass my endoscope behind the voice box into the upper esophagus to note the sphincter. This will also elicit the symptoms, just as externally pushing lightly on the cricoid cartilage which elicits the symptoms.

You should know the following:

  1. These symptoms are so characteristic that as soon as a patient tells me they have a lump in the throat, I can usually describe many of their symptoms to them.
  2. After the exam, just knowing the tightness is not a sign of cancer frequently helps relieve the discomfort.
  3. You will get better. Often improvement is over several weeks or even a few months, but occurs once one knows what the problem is.
  4. Warm fluids should comfort the throat. Consider a cup of warm tea (preferably without caffeine) when the lump is bothersome.
  5. If stress lets up, the symptoms improve. Think about what stress might be making this lump worse.
  6. Muscle relaxants, such as Valium, would be a good treatment, except for their addictive properties.

Medication

I sometimes dispense several Valium (perhaps 4 to 10 tablets) 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 as important as during the work week. 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 worrisome lump.

I have also tried injections with a local anesthetic, often with good, but temporary, results. It does help to confirm in the patient's mind there is the possibility of relief.

If a local anesthetic injection helps, I have with inconsistent results injected botulinum toxin into the cricopharyngeus muscle, sometimes with prolonged relief.

Benefits

The symptoms go away.

Questions

I receive more email regarding cricopharyngeal spasms than I can possibly respond to. The essence of many of the emails is that some or several symptoms are slightly different than on this page. Or perhaps, you have been examined by several ENT doctors who gave a different opinion than I do. There is really not much more I can tell you about the syndrome without examining you myself. You might consider sharing a copy of this page with your physician, though I am aware many physicians do not like the lack of peer review on the internet, but consider the page as an opening talking point about your particular case. You might also consider getting a second opinon from an ENT who specializes in the throat - a laryngologist.

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