title: Cricopharyngeal achalasia in children: botulinum toxin injection as a tool for diagnosis and treatment.
abstract: OBJECTIVE
  Characteristics and outcomes of pediatric patients undergoing cricopharyngeus injection with botulinum toxin for the treatment of cricopharyngeal achalasia were reviewed. A parental telephone survey was performed to assess improvement and satisfaction.
  
  
  METHODS
  Retrospective review of patients who underwent injection of the cricopharyngeus with botulinum toxin for cricopharyngeal achalasia. A prospective survey of postoperative symptoms and parental satisfaction was also performed.
  
  
  METHODS
  After institutional review board approval, children with cricopharyngeal achalasia who underwent injection with botulinum toxin were identified. Specific parameters were recorded for each patient. A survey of the parents' satisfaction and subjective improvement was then conducted.
  
  
  RESULTS
  Six children were identified with cricopharyngeal achalasia, with an age range of 3 months to 10 years. Symptoms varied and five of the six children required some form of altered nutrition. Preoperative studies varied, and the number of injections ranged from one to three per patient. One child had transient worsening of aspiration. Two children benefited from injections and went on to myotomy, while four children did not require myotomy and their symptoms were treated with injections alone. A parental survey was performed via telephone. All parents were satisfied with the procedure. Three children were symptom-free, and three children still exhibit some dysphagia.
  
  
  CONCLUSIONS
  Botulinum toxin injection is a useful tool to help diagnose and treat pediatric cricopharyngeal achalasia. More research is needed to elucidate optimal dosing, frequency of injections, and when to move on to surgical intervention.
  
  
  METHODS
  4.
authors.affiliation: Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, Colorado; Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Scholes
authors.forename: Timothy
authors.initials: T
authors.lastname: McEvoy
authors.forename: Hayat
authors.initials: H
authors.lastname: Mousa
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wiet
mesh_terms: D001037:Aphasia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000002:abnormalities* / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D010608:Pharyngeal Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Cricopharyngeal achalasia; botulinum toxin; cricopharyngeus; dysphagia