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[DYSPHAGIA] cricopharyngeal spasms
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RE: [DYSPHAGIA] cricopharyngeal spasms
----- Original Message -----=20
From: Quinn, Darin=20
To: Phyllis Palmer ; Larry/Pam Seibert ; 'I Campbell-Taylor'=20
Cc: dysphagia@medonline.com=20
Sent: Monday, March 12, 2001 11:55 AM
Subject: RE: [DYSPHAGIA] cricopharyngeal spasms
I have a series of VFSS that I am sure show the development of a =
Zenker's from initial "wavy" indentations on the posterior pharyngeal =
wall, through cricopharyngeal bar to frank Zenker's.
Irene.
It's an interesting subject as many of the radiologists here dismiss =
the prescence of a CP bar as a normal variation, particularly when the =
oral/pharyngeal swallow mechanism appears to be working normally (even =
though these patients come in with real complaints of globus, etc.). =
What do you think about the relationship between CP bar and GER? (as =
noted in Brady, A.P.; Stevenson, G.W.; Somers, S.; Hough, D.M.; Di =
Giandomenico, E. (1995) Abdom Imaging 20:225-229.)
----------=20
From: I Campbell-Taylor[SMTP:icampbelltaylor@sympatico.ca]=20
Sent: March 11, 2001 12:50 PM=20
To: Phyllis Palmer; Larry/Pam Seibert=20
Cc: dysphagia@medonline.com=20
Subject: Re: [DYSPHAGIA] cricopharyngeal spasms=20
One of the most comprehensive articles on the subject is:=20
Biomechanics of cricopharyngeal bars.=20
Dantas RO; Cook IJ; Dodds WJ; Kern MK; Lang IM; Brasseur JG=20
Gastroenterology, 99:1269-74 1990=20
Patients with a prominent cricopharyngeal bar visible on radiography =
are=20
generally considered to have spasm of the cricopharyngeus, which is =
the=20
major muscle component of the upper esophageal sphincter. This =
condition has=20
been termed "cricopharyngeal achalasia". The aim of this study was =
to=20
determine the pathogenesis of cricopharyngeal bars. Concurrent=20
videofluoroscopic and manometric examinations of the pharynx and =
upper=20
esophageal sphincter were performed in a cohort of six patients with =
prominent cricopharyngeal bars and in eight control volunteers. In =
each=20
subject, swallows of 2-30-mL barium boluses were recorded. The =
patients with=20
cricopharyngeal bars showed (a) normal peristaltic contraction in =
the=20
pharynx, (b) normal axial upper esophageal sphincter pressure and=20
relaxation, (c) normal flow rate across the upper esophageal =
sphincter, and=20
(d) normal duration of upper esophageal sphincter opening for =
different=20
bolus volumes. The major abnormalities in the patients with =
cricopharyngeal=20
bars were (a) reduced maximal dimensions of the upper esophageal =
sphincter=20
during the transsphincteric flow of barium and (b) increased =
intrabolus=20
pressure upstream to the upper esophageal sphincter. Thus, the =
increase in=20
intrabolus pressure preserved normal transsphincteric flow rates =
even though=20
the upper esophageal sphincter did not open normally. Overall, the=20
constellation of findings in the patients studied suggests that the=20
underlying pathogenesis of their cricopharyngeal bar was reduced =
muscle=20
compliance wherein the relaxed cricopharyngeus did not distend =
normally=20
during swallowing.=20
This would seem to imply that resistance within the muscles of the =
CP (slow=20
twitch fiber muscles, mainly) prevent the mechanical stretching =
required by=20
the hyoid attachments and/or did not distend following applied =
pressure of=20
the bolus.=20
Comments?=20
Irene.=20
----- Original Message -----=20
From: Phyllis Palmer <ppalmer@medonline.com>=20
To: Larry/Pam Seibert <lpseibert@home.com>=20
Cc: <dysphagia@medonline.com>=20
Sent: Sunday, March 11, 2001 12:22 AM=20
Subject: Re: [DYSPHAGIA] cricopharyngeal spasms=20
> Pam,=20
>=20
> Opening of the UES is accomplished by passive stretch due to =
hyolaryngeal=20
> elevation, widening from intrabolus pressure, and relaxation of =
the CP=20
> muscle. I would want to know more about what he saw at teh level =
of the=20
> UES and what led him to diagnose a spasm. Did he do EMG durign =
swallowing=20
> to not CP relaxation patterns? While I am sure the answer is no, I =
say=20
> this because I am not certain that you can tell the CP is spasming =
from=20
> susopending a scope in the pharynx (at least I can't)...you guys =
who do=20
> lots of scoping, what is your experience with being able to =
identify=20
> dysfunction of the CP muscle within the UES.=20
>=20
> If the problem is related to CP relaxation then some docs may =
consider=20
> botox or bougie before they consider myotomy. If the issue is =
relatred to=20
> either of the other 2 components of the UES opening, you have some =
rx=20
> techniques you can try,=20
>=20
> Woudl love to hear how others deal with prominent CP muscles...or =
what=20
> folks do when they see a CP bar on video?=20
>=20
> Phyllis=20
>=20
>=20
> On Thu, 8 Mar 2001, Larry/Pam Seibert wrote:=20
>=20
> > Am scheduled to see a quadraplegic tomorrow who is on a cuffless =
trach=20
> > and was recently scoped because he started having trouble =
swallowing=20
> > solids. He complained that there was difficulty at the level of =
the=20
> > trach. He was on a regular diet for years prior to this.=20
> >=20
> > When scoped the physician ordered 2 months of speech therapy to=20
> > strengthen the swallow before considering a myotomy. A spasm =
was noted=20
> > at the level of the cricophayngus.=20
> >=20
> > I haven't done much of this before and would appreciate anyone's =
advice=20
> > on such a case.=20
> >=20
> > Pam=20
> >=20
> > =
---------------------------------------------------------------------=20
> > To UNSUBSCRIBE from this list, please send an e-mail message to=20
> > majordomo@medonline.com with the following text as a message:=20
> > unsubscribe dysphagia=20
> > =
---------------------------------------------------------------------=20
> >=20
>=20
> --=20
> __________________________________________________________=20
> Phyllis M. Palmer, Ph.D. Speech Language Pathologist=20
> www. dysphagia.com=20
> __________________________________________________________=20
>=20
> =
---------------------------------------------------------------------=20
> To UNSUBSCRIBE from this list, please send an e-mail message to=20
> majordomo@medonline.com with the following text as a message:=20
> unsubscribe dysphagia=20
> =
---------------------------------------------------------------------=20
=
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To UNSUBSCRIBE from this list, please send an e-mail message to=20
majordomo@medonline.com with the following text as a message:=20
unsubscribe dysphagia=20
=
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<HTML><HEAD><TITLE>RE: [DYSPHAGIA] cricopharyngeal spasms</TITLE>
<META content=3D"text/html; charset=3Diso-8859-1" =
http-equiv=3DContent-Type>
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<BODY bgColor=3D#ffffff>
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<BLOCKQUOTE=20
style=3D"BORDER-LEFT: #000000 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: =
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<DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV=20
style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
<A href=3D"mailto:QuinnD@rvh.on.ca"; title=3DQuinnD@rvh.on.ca>Quinn, =
Darin</A>=20
</DIV>
<DIV style=3D"FONT: 10pt arial"><B>To:</B> <A=20
href=3D"mailto:ppalmer@medonline.com"; =
title=3Dppalmer@medonline.com>Phyllis=20
Palmer</A> ; <A href=3D"mailto:lpseibert@home.com"=20
title=3Dlpseibert@home.com>Larry/Pam Seibert</A> ; <A=20
href=3D"mailto:icampbelltaylor@sympatico.ca"=20
title=3Dicampbelltaylor@sympatico.ca>'I Campbell-Taylor'</A> </DIV>
<DIV style=3D"FONT: 10pt arial"><B>Cc:</B> <A=20
href=3D"mailto:dysphagia@medonline.com"=20
title=3Ddysphagia@medonline.com>dysphagia@medonline.com</A> </DIV>
<DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Monday, March 12, 2001 =
11:55=20
AM</DIV>
<DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: [DYSPHAGIA] =
cricopharyngeal=20
spasms</DIV>
<DIV><FONT face=3DArial size=3D2>I have a series of VFSS that I am =
sure show the=20
development of a Zenker's from initial "wavy" indentations on the =
posterior=20
pharyngeal wall, through cricopharyngeal bar to frank =
Zenker's.</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>Irene.<BR></DIV></FONT>
<P><FONT color=3D#0000ff face=3DArial size=3D2>It's an interesting =
subject as many=20
of the radiologists here dismiss the prescence of a CP bar as a normal =
variation, particularly when the oral/pharyngeal swallow mechanism =
appears to=20
be working normally (even though these patients come in with real =
complaints=20
of globus, etc.). What do you think about the relationship =
between CP=20
bar and GER? (as noted in Brady, A.P.; Stevenson, G.W.; Somers, =
S.;=20
Hough, D.M.; Di Giandomenico, E. (1995) Abdom Imaging=20
20:225-229.)</FONT></P><BR>
<UL>
<P><FONT face=3D"MS Sans Serif" size=3D2>----------</FONT> =
<BR><B><FONT=20
face=3D"MS Sans Serif" size=3D2>From:</FONT></B> <FONT=20
face=3D"MS Sans Serif" size=3D2>I Campbell-Taylor[<A=20
=
href=3D"mailto:SMTP:icampbelltaylor@sympatico.ca";>SMTP:icampbelltaylor@sy=
mpatico.ca</A>]</FONT>=20
<BR><B><FONT face=3D"MS Sans Serif" size=3D2>Sent:</FONT></B> =
<FONT=20
face=3D"MS Sans Serif" size=3D2>March 11, 2001 12:50 PM</FONT> =
<BR><B><FONT=20
face=3D"MS Sans Serif" size=3D2>To:</FONT></B> =
<FONT=20
face=3D"MS Sans Serif" size=3D2>Phyllis Palmer; Larry/Pam =
Seibert</FONT>=20
<BR><B><FONT face=3D"MS Sans Serif" size=3D2>Cc:</FONT></B> =
=20
<FONT face=3D"MS Sans Serif" size=3D2>dysphagia@medonline.com</FONT> =
<BR><B><FONT face=3D"MS Sans Serif" size=3D2>Subject:</FONT></B>=20
<FONT face=3D"MS Sans Serif" =
size=3D2>Re:=20
[DYSPHAGIA] cricopharyngeal spasms</FONT> </P>
<P><FONT face=3DArial size=3D2>One of the most comprehensive =
articles on the=20
subject is:</FONT> </P>
<P><FONT face=3DArial size=3D2>Biomechanics of cricopharyngeal =
bars.</FONT>=20
<BR><FONT face=3DArial size=3D2>Dantas RO; Cook IJ; Dodds WJ; Kern =
MK; Lang IM;=20
Brasseur JG</FONT> <BR><FONT face=3DArial size=3D2>Gastroenterology, =
99:1269-74 1990</FONT> <BR><FONT face=3DArial =
size=3D2>Patients with a=20
prominent cricopharyngeal bar visible on radiography are</FONT> =
<BR><FONT=20
face=3DArial size=3D2>generally considered to have spasm of the =
cricopharyngeus,=20
which is the</FONT> <BR><FONT face=3DArial size=3D2>major muscle =
component of=20
the upper esophageal sphincter. This condition has</FONT> <BR><FONT=20
face=3DArial size=3D2>been termed "cricopharyngeal achalasia". =
The aim of=20
this study was to</FONT> <BR><FONT face=3DArial size=3D2>determine =
the=20
pathogenesis of cricopharyngeal bars. Concurrent</FONT> <BR><FONT =
face=3DArial=20
size=3D2>videofluoroscopic and manometric examinations of the =
pharynx and=20
upper</FONT> <BR><FONT face=3DArial size=3D2>esophageal sphincter =
were performed=20
in a cohort of six patients with</FONT> <BR><FONT face=3DArial=20
size=3D2>prominent cricopharyngeal bars and in eight control =
volunteers. In=20
each</FONT> <BR><FONT face=3DArial size=3D2>subject, swallows of =
2-30-mL barium=20
boluses were recorded. The patients with</FONT> <BR><FONT =
face=3DArial=20
size=3D2>cricopharyngeal bars showed (a) normal peristaltic =
contraction in=20
the</FONT> <BR><FONT face=3DArial size=3D2>pharynx, (b) normal axial =
upper=20
esophageal sphincter pressure and</FONT> <BR><FONT face=3DArial=20
size=3D2>relaxation, (c) normal flow rate across the upper =
esophageal=20
sphincter, and</FONT> <BR><FONT face=3DArial size=3D2>(d) normal =
duration of=20
upper esophageal sphincter opening for different</FONT> <BR><FONT =
face=3DArial=20
size=3D2>bolus volumes. The major abnormalities in the patients with =
cricopharyngeal</FONT> <BR><FONT face=3DArial size=3D2>bars were (a) =
reduced=20
maximal dimensions of the upper esophageal sphincter</FONT> =
<BR><FONT=20
face=3DArial size=3D2>during the transsphincteric flow of barium and =
(b)=20
increased intrabolus</FONT> <BR><FONT face=3DArial size=3D2>pressure =
upstream to=20
the upper esophageal sphincter. Thus, the increase in</FONT> =
<BR><FONT=20
face=3DArial size=3D2>intrabolus pressure preserved normal =
transsphincteric flow=20
rates even though</FONT> <BR><FONT face=3DArial size=3D2>the upper =
esophageal=20
sphincter did not open normally. Overall, the</FONT> <BR><FONT =
face=3DArial=20
size=3D2>constellation of findings in the patients studied suggests =
that=20
the</FONT> <BR><FONT face=3DArial size=3D2>underlying pathogenesis =
of their=20
cricopharyngeal bar was reduced muscle</FONT> <BR><FONT face=3DArial =
size=3D2>compliance wherein the relaxed cricopharyngeus did not =
distend=20
normally</FONT> <BR><FONT face=3DArial size=3D2>during =
swallowing.</FONT> </P>
<P><FONT face=3DArial size=3D2>This would seem to imply that =
resistance within=20
the muscles of the CP (slow</FONT> <BR><FONT face=3DArial =
size=3D2>twitch fiber=20
muscles, mainly) prevent the mechanical stretching required =
by</FONT>=20
<BR><FONT face=3DArial size=3D2>the hyoid attachments and/or did not =
distend=20
following applied pressure of</FONT> <BR><FONT face=3DArial =
size=3D2>the=20
bolus.</FONT> <BR><FONT face=3DArial size=3D2>Comments?</FONT> =
<BR><FONT=20
face=3DArial size=3D2>Irene.</FONT> </P>
<P><FONT face=3DArial size=3D2>----- Original Message -----</FONT> =
<BR><FONT=20
face=3DArial size=3D2>From: Phyllis Palmer =
<ppalmer@medonline.com></FONT>=20
<BR><FONT face=3DArial size=3D2>To: Larry/Pam Seibert=20
<lpseibert@home.com></FONT> <BR><FONT face=3DArial =
size=3D2>Cc:=20
<dysphagia@medonline.com></FONT> <BR><FONT face=3DArial =
size=3D2>Sent:=20
Sunday, March 11, 2001 12:22 AM</FONT> <BR><FONT face=3DArial =
size=3D2>Subject:=20
Re: [DYSPHAGIA] cricopharyngeal spasms</FONT> </P><BR>
<P><FONT face=3DArial size=3D2>> Pam,</FONT> <BR><FONT =
face=3DArial=20
size=3D2>></FONT> <BR><FONT face=3DArial size=3D2>> Opening of =
the UES is=20
accomplished by passive stretch due to hyolaryngeal</FONT> <BR><FONT =
face=3DArial size=3D2>> elevation, widening from intrabolus =
pressure, and=20
relaxation of the CP</FONT> <BR><FONT face=3DArial size=3D2>> =
muscle. I would=20
want to know more about what he saw at teh level of the</FONT> =
<BR><FONT=20
face=3DArial size=3D2>> UES and what led him to diagnose a spasm. =
Did he do=20
EMG durign swallowing</FONT> <BR><FONT face=3DArial size=3D2>> to =
not CP=20
relaxation patterns? While I am sure the answer is no, I say</FONT>=20
<BR><FONT face=3DArial size=3D2>> this because I am not certain =
that you can=20
tell the CP is spasming from</FONT> <BR><FONT face=3DArial =
size=3D2>>=20
susopending a scope in the pharynx (at least I can't)...you guys who =
do</FONT> <BR><FONT face=3DArial size=3D2>> lots of scoping, what =
is your=20
experience with being able to identify</FONT> <BR><FONT face=3DArial =
size=3D2>> dysfunction of the CP muscle within the UES.</FONT> =
<BR><FONT=20
face=3DArial size=3D2>></FONT> <BR><FONT face=3DArial =
size=3D2>> If the=20
problem is related to CP relaxation then some docs may =
consider</FONT>=20
<BR><FONT face=3DArial size=3D2>> botox or bougie before they =
consider=20
myotomy. If the issue is relatred to</FONT> <BR><FONT face=3DArial =
size=3D2>>=20
either of the other 2 components of the UES opening, you have some =
rx</FONT>=20
<BR><FONT face=3DArial size=3D2>> techniques you can try,</FONT> =
<BR><FONT=20
face=3DArial size=3D2>></FONT> <BR><FONT face=3DArial =
size=3D2>> Woudl love to=20
hear how others deal with prominent CP muscles...or what</FONT> =
<BR><FONT=20
face=3DArial size=3D2>> folks do when they see a CP bar on =
video?</FONT>=20
<BR><FONT face=3DArial size=3D2>></FONT> <BR><FONT face=3DArial =
size=3D2>>=20
Phyllis</FONT> <BR><FONT face=3DArial size=3D2>></FONT> <BR><FONT =
face=3DArial=20
size=3D2>></FONT> <BR><FONT face=3DArial size=3D2>> On Thu, 8 =
Mar 2001,=20
Larry/Pam Seibert wrote:</FONT> <BR><FONT face=3DArial =
size=3D2>></FONT>=20
<BR><FONT face=3DArial size=3D2>> > Am scheduled to see a =
quadraplegic=20
tomorrow who is on a cuffless trach</FONT> <BR><FONT face=3DArial =
size=3D2>>=20
> and was recently scoped because he started having trouble=20
swallowing</FONT> <BR><FONT face=3DArial size=3D2>> > =
solids. He=20
complained that there was difficulty at the level of the</FONT> =
<BR><FONT=20
face=3DArial size=3D2>> > trach. He was on a regular =
diet for years=20
prior to this.</FONT> <BR><FONT face=3DArial size=3D2>> =
></FONT> <BR><FONT=20
face=3DArial size=3D2>> > When scoped the physician ordered 2 =
months of=20
speech therapy to</FONT> <BR><FONT face=3DArial size=3D2>> > =
strengthen=20
the swallow before considering a myotomy. A spasm was =
noted</FONT>=20
<BR><FONT face=3DArial size=3D2>> > at the level of the=20
cricophayngus.</FONT> <BR><FONT face=3DArial size=3D2>> =
></FONT> <BR><FONT=20
face=3DArial size=3D2>> > I haven't done much of this before =
and would=20
appreciate anyone's advice</FONT> <BR><FONT face=3DArial =
size=3D2>> > on=20
such a case.</FONT> <BR><FONT face=3DArial size=3D2>> ></FONT> =
<BR><FONT=20
face=3DArial size=3D2>> > Pam</FONT> <BR><FONT face=3DArial =
size=3D2>>=20
></FONT> <BR><FONT face=3DArial size=3D2>> >=20
=
---------------------------------------------------------------------</FO=
NT>=20
<BR><FONT face=3DArial size=3D2>> > To UNSUBSCRIBE from this =
list, please=20
send an e-mail message to</FONT> <BR><FONT face=3DArial =
size=3D2>> >=20
majordomo@medonline.com with the following text as a message:</FONT> =
<BR><FONT face=3DArial size=3D2>> > unsubscribe =
dysphagia</FONT> <BR><FONT=20
face=3DArial size=3D2>> >=20
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---------------------------------------------------------------------</FO=
NT>=20
<BR><FONT face=3DArial size=3D2>> ></FONT> <BR><FONT =
face=3DArial=20
size=3D2>></FONT> <BR><FONT face=3DArial size=3D2>> --</FONT> =
<BR><FONT=20
face=3DArial size=3D2>>=20
__________________________________________________________</FONT> =
<BR><FONT=20
face=3DArial size=3D2>> Phyllis M. Palmer,=20
Ph.D. Speech Language =
Pathologist</FONT>=20
<BR><FONT face=3DArial=20
=
size=3D2>> =
=20
www. dysphagia.com</FONT> <BR><FONT face=3DArial size=3D2>>=20
__________________________________________________________</FONT> =
<BR><FONT=20
face=3DArial size=3D2>></FONT> <BR><FONT face=3DArial =
size=3D2>>=20
=
---------------------------------------------------------------------</FO=
NT>=20
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