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Updated: Sep 18, 2025

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Office v OR Injection for Retrograde Cricopharyngeal Dysfunction: Evidence-Based Treatment Algorithm.

Rachel B Kutler1, Sana H Siddiqui1, Courtney B Tipton2

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|June 20, 2025
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Summary

Both in-office (IO) and operating room (OR) botulinum toxin (BTX) injections effectively treat retrograde cricopharyngeal dysfunction (RCPD). While initial relief is similar, IO injections may require repeat treatments more often than OR injections.

Keywords:
botulinum toxinin‐office proceduresretrograde cricopharyngeal dysfunction

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Area of Science:

  • Otolaryngology
  • Gastroenterology
  • Speech-Language Pathology

Background:

  • Retrograde cricopharyngeal dysfunction (RCPD) is a condition affecting swallowing.
  • Botulinum toxin (BTX) injections are a treatment option for RCPD.
  • The optimal delivery method for BTX injections (in-office vs. operating room) is under investigation.

Purpose of the Study:

  • To compare the efficacy and outcomes of in-office (IO) versus operating room (OR) botulinum toxin (BTX) injections for treating retrograde cricopharyngeal dysfunction (RCPD).
  • To evaluate success rates, repeat injection rates, and long-term outcomes for both IO and OR BTX injection approaches in RCPD patients.

Main Methods:

  • A prospective study included adult patients diagnosed with RCPD who received either IO or OR BTX injections.
  • Procedure success was determined by patient-reported symptom improvement.
  • Chi-squared tests analyzed success and repeat injection rates; primary treatment included one or two IO injections or one OR injection.

Main Results:

  • Initial symptom relief was comparable between IO and OR injections (90.7% vs. 91.0%).
  • Repeat injection rates were higher for IO injections (26.2% within 8 weeks, 54.2% overall).
  • Two IO injections showed comparable long-term success to one OR injection (77.8% vs. 70.5%).

Conclusions:

  • Both OR and IO BTX injections are effective treatments for RCPD.
  • A treatment algorithm can guide the selection of injection approach based on patient response.
  • Further research is needed on long-term outcomes and factors influencing repeat treatment rates.