Treatment of globus by upper esophageal sphincter injection with botulinum A toxin.Globus sensation is a frequent complaint by patients who present to otolaryngologists. Globus is often associated with upper esophageal sphincter The upper esophageal sphincter (UES) refers to the superior portion of the esophagus. Unlike the lower esophageal sphincter, it is comprised of striated muscle and is under conscious control. (UES UES UNE (University of New England) Economics Society UES Upper East Side (Manhattan, NY) UES Upper Esophageal Sphincter UES Unified Energy Systems of Russia UES Waukesha, Wisconsin ) hypertension and abnormalities in UES relaxation. (1,2) Although globus may present in conjunction with other laryngopharyngeal reflux symptoms, the role of reflux in patients with isolated globus is unclear. (2) Treatment options for isolated globus with UES hypertension include empiric antireflux therapy, dilation dilation /di·la·tion/ (di-la´shun) 1. the act of dilating or stretching. 2. dilatation. di·la·tion n. 1. of the UES, cricopharyngeal myotomy, or injection of botulinum A toxin. A 50-year-old woman presented for evaluation of a globus sensation of several months' duration. She denied dysphonia dysphonia /dys·pho·nia/ (-fo´ne-ah) a voice impairment or speech disorder.dysphon´ic dys·pho·ni·a n. Difficulty in speaking, usually evidenced by hoarseness. , throat-clearing, and dysphagia, and she expressed no other complaints. Laryngeal examination detected no evidence of reflux laryngitis, and findings on her neck examination were normal. The results of a video-fluoroscopic swallow study were normal (no evidence of a cricopharyngeal bar), and pH probe testing was negative for pharyngeal pharyngeal /pha·ryn·ge·al/ (fah-rin´je-al) pertaining to the pharynx. pha·ryn·geal or pha·ryn·gal adj. Of, relating to, located in, or coming from the pharynx. and esophageal reflux. However, manometry manometry /ma·nom·e·try/ (-e-tre) the measurement of pressure by means of a manometer. anal manometry demonstrated a significantly elevated cricopharyngeal resting pressure and elevated peak pharyngeal pressures with swallowing (figure, A). [FIGURE OMITTED] The patient was treated with an electromyographically guided injection of 6 units of botulinum A toxin into the cricopharyngeal muscle bilaterally. Immediately thereafter, she experienced mild dysphagia secondary to altered swallowing biomechanics. But by 4 weeks postinjection, both the dysphagia and the globus sensation had resolved. Follow-up manometry revealed that her UES resting pressures had decreased to approximately 100 mm Hg with complete relaxation on swallowing (figure, B). References (1.) Sun J, Xu B, Yuan YZ, Xu JY. Study on the function of pharynx pharynx (fâr`ĭngks), area of the gastrointestinal and respiratory tracts which lies between the mouth and the esophagus. In humans, the pharynx is a cone-shaped tube about 4 1-2 in. (11.43 cm) long. upper esophageal sphincter in globus hystericus. World J Gastroenterol 2002;8:952-5. (2.)Corso MJ, Pursnani KG, Mohiuddin MA, et al. Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux. Dig Dis Sci 1998;43:1513-17. From the Center for Voice and Swallowing Disorders of Wake Forest University, Winston-Salem, N.C.; www.thevoicecenter.org |
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