Illustration of smooth swallowing with relaxed throat muscles.

Swallowing Made Easier: Botulinum Toxin for Pharyngeal Dysphagia

Nico Varela in Health & Wellness December 2025 • 4 min read.

"Discover how a simple endoscopic injection can bring relief to those struggling with cricopharyngeal dysfunction."

Dysphagia, or difficulty swallowing, is more than just an inconvenience—it’s a widespread issue, especially for individuals with neurological conditions such as stroke, head trauma, or Parkinson's disease. When swallowing becomes a struggle, it can lead to serious complications like aspiration, weight loss, and a diminished quality of life. Understanding the available treatments is crucial for managing this condition effectively.

One promising solution is the endoscopic botulinum toxin injection. This minimally invasive procedure targets the cricopharyngeal (CP) muscle, a key component of the upper esophageal sphincter (UES). When the CP muscle doesn't relax properly, it can obstruct the passage of food and liquids, leading to dysphagia. By injecting botulinum toxin directly into the CP muscle, doctors can help it relax, making swallowing easier.

While surgical options like CP myotomy exist, they come with potential risks, including injury to the recurrent laryngeal nerve and the need for general anesthesia. Dilation treatments, another alternative, may offer only temporary relief. Endoscopic botulinum toxin injection, however, presents a less invasive approach with potentially fewer complications, offering a beacon of hope for those seeking relief from pharyngeal dysphagia.

How Does Botulinum Toxin Injection Work for Dysphagia?

Illustration of smooth swallowing with relaxed throat muscles.

The study published in the Scandinavian Journal of Gastroenterology explored the effectiveness of endoscopic botulinum toxin injections in patients with pharyngeal dysphagia due to cricopharyngeal dysfunction. Researchers retrospectively reviewed the cases of fourteen patients who underwent this procedure at a single medical center between 2006 and 2017. These patients all suffered from neurological disorders that contributed to their swallowing difficulties.

During the procedure, a total dose of 100 international units (IU) of botulinum toxin was injected directly into the CP muscle under endoscopic vision. The success of the procedure was evaluated using several measures, including:

Clinical resolution of previous symptoms (e.g., coughing, choking, and regurgitation)
Functional Oral Intake Scale (FOIS) to assess swallowing ability
Videofluoroscopic Swallowing Study (VFSS) to check for decreased barium retention at the pyriform sinus and epiglottic vallecula

The results of the study were encouraging. Eleven out of the fourteen patients (78.6%) experienced significant improvement after the botulinum toxin injection. These patients showed clinical improvement in their symptoms and decreased barium retention on VFSS. This suggests that endoscopic botulinum toxin injection can be a safe and effective treatment option for patients with pharyngeal dysphagia related to cricopharyngeal dysfunction.

The Future of Dysphagia Treatment

Endoscopic botulinum toxin injection offers a promising treatment option for individuals struggling with pharyngeal dysphagia due to cricopharyngeal dysfunction. Its minimally invasive nature and encouraging success rates make it an appealing alternative to more invasive surgical procedures. While more research is needed to fully understand the long-term effects and optimal use of this treatment, it represents a significant step forward in improving the quality of life for those affected by swallowing disorders.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1080/00365521.2018.1506820, Alternate LINK

Title: Endoscopic Botulinum Toxin Injection For Treatment Of Pharyngeal Dysphagia In Patients With Cricopharyngeal Dysfunction

Subject: Gastroenterology

Journal: Scandinavian Journal of Gastroenterology

Publisher: Informa UK Limited

Authors: Seok-Hoo Jeong, Yu Jin Kim, Yoon Jae Kim, Ki Deok Park, Eui Joo Kim, Jun-Won Chung, Kwang An Kwon, Kyoung Oh Kim, Dong Kyun Park, Jung Ho Kim, Jae Hee Cho

Published: 2018-10-24

Everything You Need To Know

What is pharyngeal dysphagia, and why is it a serious concern?

Pharyngeal dysphagia is difficulty swallowing that specifically affects the pharynx, the part of the throat behind the mouth and nasal cavity. It's a serious issue because it can lead to aspiration, where food or liquid enters the lungs, causing pneumonia and other complications. This can also lead to weight loss and a reduced quality of life. People with neurological conditions such as stroke, head trauma, or Parkinson's disease are at higher risk of experiencing this condition.

How does an endoscopic botulinum toxin injection help with pharyngeal dysphagia?

Endoscopic botulinum toxin injections target the cricopharyngeal (CP) muscle, a crucial part of the upper esophageal sphincter (UES). When the CP muscle doesn't relax properly, it obstructs the passage of food and liquids, causing dysphagia. Injecting botulinum toxin directly into the CP muscle helps it to relax, making swallowing easier. This approach is particularly helpful for individuals experiencing pharyngeal dysphagia caused by cricopharyngeal dysfunction.

What are the benefits of botulinum toxin injection compared to other treatments like CP myotomy or dilation?

Botulinum toxin injections offer a less invasive alternative to surgical options like CP myotomy, which carry risks such as injury to the recurrent laryngeal nerve and the need for general anesthesia. Dilation treatments may only provide temporary relief. The endoscopic botulinum toxin injection is minimally invasive with potentially fewer complications, making it a promising treatment for those seeking relief from pharyngeal dysphagia caused by cricopharyngeal dysfunction. The use of 100 international units (IU) of botulinum toxin injected directly into the CP muscle under endoscopic vision has shown encouraging results.

How was the effectiveness of endoscopic botulinum toxin injections measured in the study mentioned?

The study assessed the success of the procedure using several measures. These included the clinical resolution of previous symptoms like coughing, choking, and regurgitation. The Functional Oral Intake Scale (FOIS) was used to assess swallowing ability. Additionally, Videofluoroscopic Swallowing Study (VFSS) was conducted to check for decreased barium retention at the pyriform sinus and epiglottic vallecula, confirming the improved swallowing function after the botulinum toxin injection. The study showed significant improvement in symptoms and swallowing ability in a majority of patients.

What does the future of dysphagia treatment look like, and what further research is needed?

Endoscopic botulinum toxin injection is a promising treatment option for pharyngeal dysphagia caused by cricopharyngeal dysfunction. Its minimally invasive nature and encouraging success rates highlight its potential. More research is needed to fully understand the long-term effects and to determine the optimal use of this treatment. Further studies will contribute to refining the treatment protocols, enhancing patient outcomes, and improving the overall quality of life for individuals affected by swallowing disorders.