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Endoscopic-guided injection of botulinum toxin into the cricopharyngeus muscle: our experience

  • S D Sharma (a1), G Kumar (a1), A Eweiss (a1), P Chatrath (a1) and H Kaddour (a1)...



To assess the efficacy of endoscopic-guided botulinum toxin injection into the cricopharyngeus muscle and evaluate the duration of its effects.


A 3-year prospective study of 12 patients undergoing injection of botulinum toxin was conducted, with a telephone survey to assess dysphagia pre-operatively, and at 1, 3 and 6 months post-treatment, using the MD Anderson Dysphagia Inventory.


Median age was 66.2 years. Causes of cricopharyngeal dysphagia included idiopathic cricopharyngeal hypertrophy (67 per cent), previous cerebrovascular accident (17 per cent), cranial nerve palsy (8 per cent) and previous chemoradiotherapy to the neck (8 per cent). There were no complications. Two patients had repeat injections after six months. There was significant improvement in MD Anderson Dysphagia Inventory scores at one and three months versus pre-operative scores (73.1 ± 14.9 vs 46.9 ± 7.6, p = 0.0001, and 65.1 ± 11.5 vs 46.9 ± 7.6, p = 0.0001), but not at six months (51.0 ± 11.0 vs 46.9 ± 7.6, p = 0.14).


Endoscopic-guided injection of botulinum toxin into the cricopharyngeus muscle is a safe and effective method for treating cricopharyngeal muscle dysfunction, lasting up to six months.


Corresponding author

Address for correspondence: Mr Sunil D Sharma, Department of Otorhinolaryngology, Queen's Hospital, Rom Valley Way, Romford RM7 0AG, UK Fax: +44 (0)1708 435096 E-mail:


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1Moerman, MB. Cricopharyngeal Botox injection: indications and technique. Curr Opin Otolaryngol Head Neck Surg 2006;14:431–6
2Kelly, EA, Koszewski, IJ, Jaradeh, SS, Merati, AL, Blumin, JH, Bock, JM. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol 2013;122:100–8
3Kelly, JH. External approach to cricopharyngeus muscle (CP) myotomy. Oper Tech Otolaryngol Head Neck Surg 1997;8:193–8
4McKenna, JA, Dedo, HH. Cricopharyngeal myotomy; indications and technique. Ann Otol Rhinol Laryngol 1992;101:216–21
5Allen, J, White, CJ, Leonard, R, Belafsky, PC. Effect of cricopharyngeus muscle surgery on the pharynx. Laryngoscope 2010;120:1498–503
6Dauer, E, Salassa, J, Iuga, L, Kasperbauer, J. Endoscopic laser vs open approach for cricopharyngeal myotomy. Otolaryngol Head Neck Surg 2006;134:830–5
7Schneider, I, Thumfart, WF, Pototschnig, C, Eckel, HE. Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol 1994;103:31–5
8Parameswaran, MS, Soliman, AM. Endoscopic botulinum toxin injection for cricopharyngeal dysphagia. Ann Otol Rhinol Laryngol 2002;111:871–4
9Murry, T, Wasserman, T, Carrau, RL, Castillo, B. Injection of botulinum toxin A for the treatment of dysfunction of the upper oesophageal sphincter. Am J Otolaryngol 2005;26:157–62
10Scholes, MA, McEvoy, T, Mousa, H, Wiet, GJ. Cricopharyngeal achalasia in children: botulinum toxin injection as a tool for diagnosis and treatment. Laryngoscope 2014;124:1475–80
11Blitzer, A, Brin, MF. Use of botulinum toxin for diagnosis and management of cricopharyngeal achalasia. Otolaryngol Head Neck Surg 1997;116:328–30
12Chen, AY, Frankowski, R, Bishop-Leone, J, Hebert, T, Leyk, S, Lewin, J et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001;127:870–6
13GraphPad Software. QuickCalcs: Linear regression calculator. In: [12 March 2015]
14Atkinson, SI, Rees, J. Botulinum toxin for cricopharyngeal dysphagia: case reports of CT-guided injection. J Otolaryngol 1997;26:273–6
15Brant, CQ, Siqueira, ES, Ferrari, AP Jr.Botulinum toxin for oropharyngeal dysphagia: case report of flexible endoscope-guided injection. Dis Esophagus 1999;12:6873
16Alberty, J, Oelerich, M, Ludwig, K, Hartmann, S, Stoll, W. Efficacy of botulinum toxin A for treatment of upper oesophageal sphincter dysfunction. Laryngoscope 2000;110:1151–6
17Shaw, GY, Searl, JP. Botulinum toxin treatment for cricopharyngeal dysfunction. Dysphagia 2001;16:161–7
18Haapaniemi, JJ, Laurikainen, EA, Pulkkinen, J, Marttila, RJ. Botulinum toxin in the treatment of cricopharyngeal dysphagia. Dysphagia 2001;16:171–5
19Zaninotto, G, Marchese, Ragona R, Briani, C, Costantini, M, Rizzetto, C, Portale, G et al. The role of botulinum toxin injection and upper oesophageal sphincter myotomy in treating oropharyngeal dysphagia. J Gastrointest Surg 2004;8:9971006
20Liu, LW, Tarnopolsky, M, Armstrong, D. Injection of botulinum toxin A to the upper oesophageal sphincter for oropharyngeal dysphagia in two patients with inclusion body myositis. Can J Gastroenterol 2004;18:397–9
21Chiu, MJ, Chang, YC, Hsiao, TY. Prolonged effect of botulinum toxin injection in the treatment of cricopharyngeal dysphagia: case report and literature review. Dysphagia 2004;19:52–7
22Kim, DY, Park, CI, Ohn, SH, Moon, JY, Chang, WH, Park, SW. Botulinum toxin type A for poststroke cricopharyngeal muscle dysfunction. Arch Phys Med Rehabil 2006;87:1346–51
23Masiero, S, Briani, C, Marchese-Ragona, R, Giacometti, P, Constantini, M, Zaninotto, G. Successful treatment of longstanding post-stroke dysphagia with botulinum toxin and rehabilitation. J Rehabil Med 2006;38:201–3
24Restivo, DA, Marchese-Ragona, R, Lauria, G, Squatrito, S, Gullo, D, Vigneri, R. Botulinum toxin treatment for oropharyngeal dysphagia associated with diabetic neuropathy. Diabetes Care 2006;29:2650–3
25Suzukia, Y, Sano, N, Shinonaga, C, Fukuda, M, Hyodo, M, Morimoto, T. Successful botulinum toxin treatment of dysphagia in a spinal muscular atrophy type 2 patient. Brain Dev 2007;29:662–5
26Krause, E, Schirra, J, Gürkov, R. Botulinum toxin A treatment of cricopharyngeal dysphagia after subarachnoid hemorrhage. Dysphagia 2008;23:406–10
27Alfonsi, E, Merlo, IM, Ponzio, M, Montomoli, C, Tassorelli, C, Biancardi, C et al. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment. J Neurol Neurosurg Psychiatry 2010;81:5460
28Restivo, DA, Marchese-Ragona, R, Patti, F, Solaro, C, Maimone, D, Zappalá, G et al. Botulinum toxin improves dysphagia associated with multiple sclerosis. Eur J Neurol 2011;18:486–90
29Woisard-Bassols, V, Alsehri, S, Simonetta-Moreau, M. The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol 2013;270:805–15
30Davis, MV, Merati, AL, Jaradeh, SS, Blumin, JH. Myosin heavy chain composition and fiber size of the cricopharyngeus muscle in patients with achalasia and normal subjects. Ann Otol Rhinol Laryngol 2007;116:643–6


Endoscopic-guided injection of botulinum toxin into the cricopharyngeus muscle: our experience

  • S D Sharma (a1), G Kumar (a1), A Eweiss (a1), P Chatrath (a1) and H Kaddour (a1)...


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