Hello, I am Robert Bastian, Dr. Bastian, Bastian Voice Institute. If you are having a distressing,
constricted feeling or a feeling that there is a lump of phlegm in your throat that you can't
dislodge, this video is designed to give you some information about one possible explanation. An
overly contracted muscle problem in the neck called cricopharyngeal spasm. It's sometimes
called Globus sensation. Now this is a disorder not well known by many physicians, and so persons
who have it may have difficulty getting a clear diagnosis and plan for treatment. This discussion
is intended to be informational and is not for the purpose of diagnosis. The hope is
that after watching this, you may be better able to discuss your symptoms with your own physician.
A person might say "I have a few a lump, a wad of phlegm, a golf-ball, a band, a constriction." Or
they'll say "It feels like something is stuck in my throat here that I can't swallow and I
can't spit out." The sensation tends to vary a bit. Specifically, it's often worse later in the day and
it might also be worse with stress or fatigue. It also seems like the problem is in the swallowing
passage, as if it's not going to work properly when I just want to swallow my own saliva. But here is a
key symptom: when I eat lunch or dinner people will say, "I'm not as aware of the problem. It seems to be
gone or soothed by eating." However, they'll say, "When I finish eating the sensation comes back
fairly promptly." Well what else is there to say about this disorder? People with this problem tend
to be preoccupied with the symptoms, motivated to see doctors—sometimes several—to undergo a
variety of tests. They're willing to do this not simply because of the symptoms but it's often
the lack of an explanation that motivates them. It's as though they're saying, "You know, I know
this part of my neck is somehow important and nobody can tell me what is wrong there."
Now the upper esophageal sphincter, which is located right here. Here's the cricoid
cartilage, here is the swallowing passage right here, and the sphincter muscle is right where my
finger is. Now that sphincter muscle is in the upper end of the esophagus—esophagus or food
tube that runs from the throat up here into the food way or esophagus right here, leading to the
stomach. That sphincter is in a constant state of contraction. It's like a gate that's always closed
except when you swallow and something goes through there. So yours is contracted right now and mine is
contracted to when I swallow saliva or food it opens just for a second or so—it relaxes to let
the food go through and then immediately when the food or liquid goes past it contracts again.
In the fewest possible words cricopharyngeal spasm is hyper tonicity, hyper contraction
of the upper esophageal sphincter muscle or cricopharyngeus muscle right here. Well,
if the degree of contraction is normal, we are unaware of this muscle—we don't even know it's
there. When the contraction becomes too much—or hypertonic—that's when it gives rise to this
constriction or choking or feeling of something stuck. That's so disturbing to many people. Now
why, by the way, does swallowing during meals make it feel so much better? It's because that
kind of swallowing is basically therapy for an overly contracted muscle. Every time you
swallow during a meal the muscle relaxes; it let's food or liquid through during meal
times. That moment of relaxin relaxation occurs over and over every few seconds.
Now if you identify with what I've described here, consult with
your physician about the possibility that your problem might be cricopharyngeal spasm.
If that diagnosis is confirmed then he or she can direct you to an appropriate
plan of treatment. Thanks for watching this instructional video. I hope it has been helpful.