Botulinum toxin treatment for cricopharyngeal dysfunction

Hypertonicity and spasticity of the cricopharyngeal muscle (CPM) often result in dysphagia characterized by difficulty passing a bolus through the upper esophageal sphincter. Past treatments for this problem have included mechanical dilation and endoscopic and transcervical cricopharyngeal myotomy. More recently, botulinum toxin injections into the CPM have been successful, but only in isolated case studies and small series. This study reports pre- and post-botulinum toxin A injection results for 12 subjects, including patient ratings of symptom severity, changes noted during modified barium swallow studies, and, in some cases, manometry of the upper esophageal sphincter. Results indicate that botulinum toxin A treatment provided significant improvement in swallowing as indicated by patient symptom ratings and investigator ratings of function from modified barium swallow studies. Greater improvement was seen in those with more isolated CPM or Xth nerve dysfunction rather than those with more global dysphagia abnormalities.