Efficacy and Safety of Electromyography‐Guided Injection of Botulinum Toxin to Treat Retrograde Cricopharyngeus Dysfunction

Objective To report the efficacy and safety of electromyography‐guided percutaneous botulinum toxin injection into the cricopharyngeus muscle in an office setting for treatment of the inability to belch and associated symptoms caused by retrograde cricopharyngeus dysfunction (R‐CPD). Study Design Retrospective case series of treated patients. Setting Tertiary care laryngology clinic. Methods A retrospective review was performed on 18 consecutive patients who were diagnosed syndromically with R‐CPD. The combined diagnostic test and treatment—specifically, botulinum toxin injection into the cricopharyngeus muscle—was accomplished in an office setting by a single surgeon using electromyography guidance. Items assessed are efficacy, safety, complications, and duration of benefit. Results All 18 patients (100%) treated in the in‐office setting gained the ability to burp with improvement in the associated symptoms of R‐CPD at initial follow‐up. Of those who had the in‐office procedure performed initially, 80% maintained the ability to burp at 6 months with relief of all the associated symptoms of R‐CPD. No patients experienced permanent complications from the injection, but 7 patients experienced varying degrees of noisy breathing within 1 week after the procedure, which was managed with breathing techniques and resolved. Conclusion In a case series of 18 patients with R‐CPD, all patients gained the ability to burp with improvement in the majority of their symptoms of R‐CPD at the time of their initial follow‐up at 1 week. None experienced severe complications, and 7 experienced transient noisy breathing, which resolved.