I am a 28yr old SLP (Speech-Language Pathologist) and have experienced the "lump" sensation for almost 6yrs. After seeing a variety of specialists I was finally given the diagnosis of cricopharyngeal spasm which seems consistent with my symptoms- a globus sensation in the laryngeal area that comes and goes but is typically worse in the evenings. My ENT found no symptoms of reflux and being a professional in this area I am familiar with how to detect/prevent reflux and heartburn is something that I rarely experience. Despite telling my ENT that I am not anxious about the "lump" feeling, just experiencing discomfort he prescribed me Valium (2mg/day) and told me that I was probably "ignoring my anxiety". I felt no reduction of symptoms at the 2mg dosage and I've taken up to 8mg with still no results but I am hesitant to go higher. The last time I went to my general care doctor she asked about the ENT visit and when I told her I didn't see Valium as a long-term solution (really since it didn't help it was no solution at all) she wrote me a prescription for Zoloft (despite the fact that my answer to her question of "how do you deal with stress" was "well, I typically just feel normal every day stressors but I work out daily and talk to my husband")...is it obvious that I'm insulted by the swiftness in which she resorted to the "magic pill" solution?
My question is this...is there a possibility that the spasm is NOT linked to anxiety? That perhaps the muscle is simply in an involuntary spasm? What other treatment options have been explored by the medical and research community. I am not a fan of Botox injections. Is Biofeedback or CBT a possible alternative to perscription drugs? I don't like the "stop thinking about it and it will go away" strategy that is the gist of most of the peer-reviewed articles I'm finding online. I'd prefer something I can ACTIVELY DO to make it go away. Thoughts???
The cricopharyngeus muscle is a very difficult place to inject botulinum toxin, although not impossible. I have not had to resort to it except in patients who have had brain injury of some type and needed a more relaxed sphincter. Plausibly, you could visit a gastroenterologist who can physically dilate that area. I don't know of any research on the areas that you ask about such as biofeedback. Plausibly, heat on the area should also provide relief. This might be applied internally through warm drinks or externally to the neck. Still, the diagnosis needs to be correct or none of the treatments will work. Conversely, when treatments don't work I tend to go back and question the diagnosis and redo a complete examination to see if anything has been missed.