| Cricopharyngeal spasm | |
| Duration: | Several months |
| Causes: | Stress, anxiety |
| Specialty: | Psychiatry, Otorhinolaryngology |
Cricopharyngeal spasms occur in the cricopharyngeus muscle of the pharynx. Cricopharyngeal spasm is an uncomfortable but harmless and temporary disorder.
There are two sphincters in the oesophagus. They are normally contracted and they relax when one swallows so that food can pass through them going to the stomach. They then squeeze closed again to prevent regurgitation of the stomach contents and prevent air from entering the digestive system. If this normal contraction becomes a spasm, these symptoms begin.
Causes include stress and anxiety. Other causes are not yet clear.
The condition persists in the autonomic nervous system even when the original stress is relieved.
An assumption in psychiatry is that a lack of serotonin can be associated with depression and anxiety. A further assumption is that a low levels of serotonin can causes spasms in the cervical area.[1] A plausible explanation for the cricopharyngeal spasms is a lack of neurotransmitter preventing the central nervous system from detecting that the eosophagus is closed, so that the upper esophagus sphincter becomes, randomly, hypertonic.The condition can appear as a symptom of the generalized anxiety disorder. Early signs are other symptoms like difficulty or inability to eat (loss of appetite, satiety after swallowing minor quantities), headache, dry mouth at night, sleeping issues, tremor, tension in the neck, in the throat, abdominal, stomach or chest pain etc. The sequence can result from a recent stress, panic attack or worry.
The subject heads to cricopharyngeal spasms when, for instance, eating pasty food requiring more throat cleanings, like peanuts, pumpkin seeds and other nuts, becomes painful. Continuous swallowing appears with the spasms as the brain interprets the feeling as something stuck.
The vagus nerves seems to play a role in the mother condition through a neurovegetative hyperactivity or dysautonomia. It innerves the inferior pharyngeal constrictor muscle where the cricopharyngeal spasms occur.
Throat spasms can also appear after an accident, a disease, may be caused or worsened by GERD. There may be hereditary factors.
In the context of long covid psychiatrists envisioned a potential relationship with an immune reaction, involving cytokines, that would persist quietly. However, due the anxiogenic situation, stress was again present when the symptoms started.
These spasms are frequently misunderstood by the patient to be cancer due to the 'lump in the throat' feeling (Globus pharyngis) that is symptomatic of this syndrome.
All the anatomic examinations can appear normal despite the condition. The throat endoscopy can objectify that nothing is stuck, that there is no lesion or inflammation. The barium swallow can miss that the sphincter is hypertonic if it does not happen during the examination, or if the sphincter still relaxes enough for the food bolus to go through. The esophageal manometry cannot detect any abnormal wave.
The cricopharyngeal spasms ("feeling that something is stuck") occur in the cricopharyngeal part of the inferior pharyngeal constrictor muscle, at the bottom of the throat. They cause muscle tension on the cricoid cartilage, leading to a globus feeling. Pharyngeal spasms, a more common source of a globus feeling, cause tension on the thyroid cartilage. They move up and down, left and right in the pharyngeal muscles. Both may be present.
The patient complains about the signs and symptoms enumerated above. The pain causes dry deglutition and dry deglutition adds to the pain, triggering a vicious circle. The spams start after dry deglutition, after the meals or randomly during the day. They can start (and stop) brutally. Or softly, by the feeling that a small pill is stuck, frictions around it, then the impression that a ball is stuck. When the spasms last long they can give the impression of a knife stabbed in the throat.
The cricopharyngeal spasms can be, for instance, formally diagnosed as part of the more general condition. For instance, did the patient recently encounter other symptoms of the generalized anxiety disorder? Does the patient have neurovegetative symptoms? Are there symptoms of dysautonomia? Is there evidence of a lack of serotonin, like no sleep (melatonin is generated from serotonin)? Is there any other psychiatric condition?
Cricopharyngeal spasms remain a rare symptom. Difficulties for the patient to describe an unusual symptom and for the practitioners to figure out the condition can entail a prompt diagnosis.
The condition is known to be temporary. In some individuals it can disappear by itself without medication. For others, it can stagnate or worsen until appropriate medical care is given.
Since the problem can last, medical specialists are not readily available and potential treatments act slowly, patience is required. During that time, finding distractions and support is a first help. Attention should be paid to not increase the levels of stress and anxiety, or fall into depression because of the symptom or its root cause.
The medical specialists to consult are ENT specialist and psychiatrist:
A cure for the condition exists and number of treatments may provide a relief.Treatments based on medicines
A typical treatment that can be prescribed starts, for instance, with nidefipine (as long as it brings a relief), a benzodiazepine (one month maximum) that has a myorelaxant effect and that can be chosen to simultaneously address other faces of the problem (anxiety, sleeping issue) and a well-tolerated anti-depressant like escitalopram (long enough so that the problem does not come back).
Treatments based on other factors
Other therapies