Botox Injection provides effective Long-Term Symptom Relief among patients with for R-CPD: JAMA

A recent case series from April 2022 to May 2024 found Retrograde Cricopharyngeus Dysfunction (R-CPD) to be associated with disabling symptoms and high rates of misdiagnosis. The findings published in the Journal of American Medical Association, revealed that in-office botulinum toxin injections (BTI) into the cricopharyngeus muscle show significant therapeutic potential for patients suffering from this condition.

R-CPD is characterized by the inability of the cricopharyngeus muscle to properly relax which results in severe discomfort and swallowing issues. Despite its debilitating nature, R-CPD remains largely undiagnosed or misdiagnosed by physicians. The exact origin of the disorder remains unknown, despite the congenital factors and family history may play a role.

The study examined a total of 106 patients, nearly evenly split between males (51.9%) and females (49.1%), who received BTI treatment for R-CPD symptoms. Most patients experienced the onset of symptoms during adolescence, with an average onset age of 13.6 years, though diagnosis was often delayed until an average age of 30.4 years.

Also, in 99.1% of cases, patients self-diagnosed their condition after multiple unsuccessful consultations, additional tests, and empirical treatments. Despite seeing medical professionals 162 times collectively, the patients reported limited progress until seeking BTI intervention.

The cumulative success rate of in-office BTI was reported at 90.6%, with 96 out of 106 patients underwent total or partial symptom relief. However, 24.5% of patients required additional injections to maintain symptom relief. The patients with a family history of R-CPD were less likely to achieve success with a single BTI treatment.

Dysphagia, or difficulty swallowing, was the most common adverse effect which affected 70.6% of patients after injections. This side effect typically lasted about 16.3 days. In 10 cases, the patients required additional botulinum toxin injections under operating room conditions after initial in-office procedures proved insufficient.

Overall, the findings of this study highlights the need for increased awareness and better diagnostic protocols for R-CPD among clinicians. However, the findings offer hope, as BTI has demonstrated high effectiveness in alleviating symptoms and improving the quality of life of patients.

Reference:

Mailly, M., Baudouin, R., Thibault, C., Hans, S., & Lechien, J. R. (2025). Origin and in-office treatment of retrograde cricopharyngeus dysfunction. JAMA Otolaryngology-- Head & Neck Surgery. https://doi.org/10.1001/jamaoto.2024.5046