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To: "VOCALIST" <vocalist>
Subject: Re: esophageal spasms
Date sent: Thu, 30 Dec 1999 07:50:32 -0500
Send reply to: VOCALIST <vocalist>

> I have a new student (69 year old baritone) who suffers from occasional
> spasms of his esophagus. These can last from a few minutes to over two
> hours and prevent him from swallowing and cause him extreme difficulty
> in speaking. The effects on his voice can be heard and felt for several
> days after an extended episode...There seems to be no history of reflux.

There are two possible areas of spasm: the upper esophagus at the
cricopharyngeal muscle - this is what people can experience as a "lump in
the throat" and can be normal if it lasts a few seconds; the other is the
lower esophagus which is relatively common in people around 70 or so and is
referred to "presbyesophagus" or "elder esophagus" (it is not limited just
to Presbyterians ;->).

The latter should have no effect on the voice. There are rarer conditions,
such as, achalasia, scleroderma and esophageal stricture which would not
affect voice directly either.

Cricopharyngeus spasm is fairly common. While the cricopharyngeus is not
involved in phonation, one often has the vocal muscles affected with spasm
at the same time. This is probably a psychophysiologic problem, with
anxiety as the root cause. Traditionally we have treated this with
antianxiety drugs and/or serotonin type antidepressants often in association
with relaxation training and speech therapy. There may be some people using
botulinum toxin, but I do not know for sure. It is somewhat difficult to
treat unless the person is good at relaxation, but is not harmful other than
to what a person wants to do. In very rare cases, it can interfere with
eating, but there are usually more serious psychological problems in these
cases.

John

John Messmer, MD, Assistant Professor, Family & Community Medicine
Medical Director, Penn State Geisinger Health Group, Palmyra, PA

"Try not. Do or do not; there is no 'try'." -- Yoda