Surgical Relaxation of the Upper Esophageal Sphincter

Peter C. Ellis, Nepean, Ontario, Canada, described his swallowing problems in Polio Network News (now Post-Polio Health), Spring 1998, Vol. 14, No. 2:

Since 1997 I have experienced moderate to severe swallowing difficulties, a constricted upper esophageal sphincter (UES), and a small anterior diverticulum (pouch) just above the UES.

After undergoing a second modified barium swallow video x-ray study in December 2001, I was asked to consider having the UES surgically relaxed (the medical term is cricopharyngeal myotomy) by an ear, nose, and throat (ENT) specialist and to explore the possibility of a feeding tube in the long run. I did not like the feeding tube solution, so I chose the UES option.

Before the operation, food and secretions pooled in my throat at the entrance to the UES. Food also collected in the pouch. I had great difficulty in passing food from my throat into my esophagus and needed up to 10 multiple swallows to get food down with sips of water.

Sometimes food that entered the upper sphincter came back up into my throat. I also had great difficulty in speaking with a clear voice through my secretions, was always coughing up mucus and secretions, and had walking pneumonia.

In January 2003, the ENT physician surgically cut the UES muscle to relax it but did not relax the muscle completely for fear of giving me reflux problems. The pouch was not repaired because it was too small.

A post-operative modified barium swallow video x-ray study revealed the following:

  • pooling of food and secretions no longer occurs,
  • swallowing is less effortful and takes less time,
  • no evidence of aspiration,
  • five multiple swallows needed instead of 10,
  • speech is clearer,
  • foodstill collects in the pouch, but the ENT doctor said the pouch will gradually disappear.

Last October, I still coughed up lots of mucus during the day, probably due to bronchiectasis (chronic dilatation of the bronchi due to infection) in the posterior bases of the right middle and left lower lobes of the lungs. My vital capacity was lower than five years ago. A scan in November showed minimal bronchiectasis. Spiriva (a long-acting inhaled bronchodilator not yet available in the U.S.) was prescribed. I also take Flovent (fluticasone inhaler to prevent asthma attacks) and Ventolin (albuterol bronchodilator) as needed. My vital capacity has improved and is 65-70% of normal, but my FEV1 is 35% to 40% of normal.

I am very happy and satisfied with the results of the surgery. It took me some time to find a willing and experienced doctor to perform the operation on a bulbar polio survivor. My ENT doctor was young, full of confidence, and had lots of experience with this operation on cancer patients; I was the first bulbar polio patient that he operated on. I would recommend this procedure to anyone who has a constricted upper esophageal sphincter and a very weak throat.

Peter C. Ellis, Nepean, Ontario, Canada,