What Treats OPMD Swallowing Difficulties?

When severe swallowing difficulties (dysphagia) cause frequent choking in Oculopharyngeal Muscular Dystrophy (OPMD), your medical team will typically use a “step-up” approach to manage your symptoms ^[1][2]. This means they will evaluate your swallowing using a formal test—such as a modified barium swallow or a specialized camera test called FEES—and then start with less invasive methods ^[3][4]. If dietary modifications and swallowing exercises stop working, doctors can offer advanced medical treatments like botulinum toxin injections or a surgery called a cricopharyngeal myotomy ^[5][2]. The primary goal of all these treatments is to help you eat safely, maintain your nutrition, and prevent aspiration pneumonia—a serious chest infection that requires urgent medical care, caused when food or liquid enters your lungs ^[6][4].

Step 1: Diet Modifications and Swallowing Exercises

Before recommending surgery, your doctor and a speech-language pathologist will usually have you try conservative management ^[2]. This often includes:

• Dietary adjustments and safe swallowing techniques: Changing the texture of your food or the thickness of your liquids can make swallowing safer ^[7]. Your team may also recommend everyday strategies like sitting perfectly upright during meals, taking smaller bites, and alternating bites of food with sips of liquid. Tracking your weight is important during this phase to ensure you get enough nutrition ^[6].
• Specialized exercises: Your care team may teach you specific rehabilitation exercises to strengthen your throat muscles ^[2]. Common examples include the Shaker maneuver (a head-lifting exercise done while lying down) and the Masako maneuver (a technique where you hold your tongue between your teeth while swallowing). Regular practice of these techniques has been shown to improve safe food intake ^[3][2].

Step 2: Botulinum Toxin Injections

If diet changes and exercises are no longer enough to prevent choking, your doctor might suggest injecting botulinum toxin (often known as Botox) ^[5].

In OPMD, the cricopharyngeal muscle—a small muscle acting as a valve at the top of your esophagus (your food pipe)—can fail to relax properly when you try to swallow. This creates a bottleneck that traps food in your throat. Injecting botulinum toxin directly into this muscle temporarily relaxes it, allowing food to pass more easily ^[5].

Because the muscle relaxation is temporary, these injections typically need to be repeated every few months to maintain the benefit. It is also important to discuss the risks with your doctor; occasionally, the toxin can spread and temporarily alter your voice or temporarily worsen swallowing ^[5].

Step 3: Cricopharyngeal Myotomy Surgery

When conservative measures and injections are no longer effective, doctors may recommend a surgical option called a cricopharyngeal myotomy ^[5][2].

During this procedure, a surgeon makes a precise cut into the overly tight cricopharyngeal muscle ^[2]. This can be done either through a small incision on the outside of your neck or endoscopically (using instruments passed down your throat) ^[2]. By physically loosening this muscle, the surgery creates a wider opening for food and liquids to flow smoothly into the esophagus ^[2].

While the cut in the muscle is permanent and provides significant relief for many patients, it is important to remember that OPMD is a progressive disease. Your swallowing function will still need to be monitored over time ^[2]. Like any operation, this procedure carries standard surgical risks, such as infection or damage to nearby tissues, which your surgeon will review with you ^[2].

Step 4: Alternative Feeding Options

For patients whose swallowing difficulties remain severe despite surgery, or for those who are not candidates for surgery, doctors can offer alternative ways to maintain nutrition. The most common option is a gastrostomy tube (often called a PEG tube), which delivers liquid nutrition directly into the stomach. This is a safe, effective, and sometimes life-saving option to bypass the throat entirely when eating by mouth becomes unsafe ^[6][4].

Knowing When to Advance Treatment

Your care team will not wait for you to experience a life-threatening lung infection before considering medical or surgical options ^[2]. Instead, they monitor for early warning signs. They will look at whether you are losing weight, if you find yourself coughing frequently during meals, or if a follow-up swallow study shows that food is slipping towards your airway ^[8][6]. Being honest with your care team about how long it takes you to eat and how often you choke is the best way to determine when it is time to take the next step in your treatment plan.