 | This article needs additional citations for verification .(November 2009) |
| Cricopharyngeal spasm | |
|---|---|
| Specialty | Psychiatry, Otorhinolaryngology |
| Duration | Several months |
| Causes | Stress, anxiety |
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[ citation needed ]. 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. [2] 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
The esophagus or oesophagus, non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. The esophagus is a fibromuscular tube, about 25 cm (10 in) long in adults, that travels behind the trachea and heart, passes through the diaphragm, and empties into the uppermost region of the stomach. During swallowing, the epiglottis tilts backwards to prevent food from going down the larynx and lungs. The word oesophagus is from Ancient Greek οἰσοφάγος (oisophágos), from οἴσω (oísō), future form of φέρω + ἔφαγον.
Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right.
An esophageal motility disorder (EMD) is any medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. The most prominent one is dysphagia.
Swallowing, sometimes called deglutition in scientific contexts, is the process in the human or animal body that allows for a substance to pass from the mouth, to the pharynx, and into the esophagus, while shutting the epiglottis. Swallowing is an important part of eating and drinking. If the process fails and the material goes through the trachea, then choking or pulmonary aspiration can occur. In the human body the automatic temporary closing of the epiglottis is controlled by the swallowing reflex.
An esophageal motility study (EMS) or esophageal manometry is a test to assess motor function of the upper esophageal sphincter (UES), esophageal body and lower esophageal sphincter (LES).
Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.
The pharyngeal reflex or gag reflex is a reflex muscular contraction of the back of the throat, evoked by touching the roof of the mouth, the back of the tongue, the area around the tonsils, the uvula, and the back of the throat. It, along with other aerodigestive reflexes such as reflexive pharyngeal swallowing, prevents objects in the oral cavity from entering the throat except as part of normal swallowing and helps prevent choking, and is a form of coughing. The pharyngeal reflex is different from the laryngeal spasm, which is a reflex muscular contraction of the vocal cords.
A Zenker's diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle. It is a pseudo diverticulum.
The inferior pharyngeal constrictor muscle is a skeletal muscle of the neck. It is the thickest of the three outer pharyngeal muscles. It arises from the sides of the cricoid cartilage and the thyroid cartilage. It is supplied by the vagus nerve. It is active during swallowing, and partially during breathing and speech. It may be affected by Zenker's diverticulum.
Oropharyngeal dysphagia arises from abnormalities of muscles, nerves or structures of the oral cavity, pharynx, and upper esophageal sphincter.
Esophageal dysphagia is a form of dysphagia where the underlying cause arises from the body of the esophagus, lower esophageal sphincter, or cardia of the stomach, usually due to mechanical causes or motility problems.
Globus pharyngis or globus sensation is the persistent but painless sensation of having a pill, food bolus, or some other sort of obstruction in the throat when there is none. Swallowing is typically performed normally, so it is not a true case of dysphagia, but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.
Esophageal spasm is a disorder of motility of the esophagus.
Nutcracker esophagus, Jackhammer esophagus, or hypercontractile peristalsis, is a disorder of the movement of the esophagus characterized by contractions in the smooth muscle of the esophagus in a normal sequence but at an excessive amplitude or duration. Nutcracker esophagus is one of several motility disorders of the esophagus, including achalasia and diffuse esophageal spasm. It causes difficulty swallowing, or dysphagia, to both solid and liquid foods, and can cause significant chest pain; it may also be asymptomatic. Nutcracker esophagus can affect people of any age but is more common in the sixth and seventh decades of life.
Diffuse esophageal spasm (DES), also known as distal esophageal spasm, is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may cause symptoms such as chest pain, similar to heart disease. In many cases, the cause of DES remains unknown.
A benign esophageal stricture, or peptic stricture, is a narrowing or tightening of the esophagus that causes swallowing difficulties.
Aphagia is the inability or refusal to swallow. The word is derived from the Ancient Greek prefix α, meaning "not" or "without," and the suffix φαγία, derived from the verb φαγεῖν, meaning "to eat." It is related to dysphagia which is difficulty swallowing, and odynophagia, painful swallowing. Aphagia may be temporary or long term, depending on the affected organ. It is an extreme, life-threatening case of dysphagia. Depending on the cause, untreated dysphagia may develop into aphagia.
Vocal cord dysfunction (VCD) is a pathology affecting the vocal folds characterized by full or partial vocal fold closure causing difficulty and distress during respiration, especially during inhalation.
Throat irritation can refer to a dry cough, a scratchy feeling at the back of the throat, a sensation of a lumpy feeling, something stuck at the back of the throat, or possibly a feeling of dust in the throat. The symptoms are unpleasant and usually temporary, but occasionally signifies a more serious health issue, such as laryngitis.
Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST), or laryngopharyngeal sensory testing, is a technique used to directly examine motor and sensory functions of swallowing so that proper treatment can be given to patients with swallowing difficulties to decrease their risk of aspiration and choking. FEESST was invented by Dr. Jonathan E. Aviv MD, FACS in 1993, and has been used by otolaryngologists, pulmonologists, gastroenterologists, intensivists and speech-language pathologists for the past 20 years.