The Spontaneous Improvement of Cricopharyngeal Achalasia in a Child with Motor Delay: A Case Report

<b>Background and Clinical Significance:</b> Cricopharyngeal achalasia (CPA) is a rare disorder of the upper esophageal sphincter (UES), characterized by failure of the cricopharyngeus muscle to relax during swallowing. Pediatric CPA is particularly uncommon and often associated with comorbidities, such as neurological impairments, developmental delays, and laryngomalacia. The existing literature primarily consists of small case series, limiting insights into its natural history, particularly spontaneous resolution. This case highlights a unique instance of spontaneous improvement in CPA, contributing valuable knowledge to pediatric otolaryngology and gastroenterology. <b>Case Presentation:</b> We report the case of a 38 months male with global motor delay, presenting with feeding difficulties, choking, and aspiration. A videofluoroscopic swallow study (VFSS) confirmed CPA with impaired bolus passage and posterior indentation consistent with a cricopharyngeus bar. Despite multidisciplinary consultations, interventional therapies were deferred due to parental preference and cricopharyngeal EMG findings, showing muscle inhibition during swallowing. Over six months, the patient exhibited a spontaneous resolution of feeding difficulties and aspiration, with the normalization of VFSS findings. This rare case suggests a distinct natural history of CPA in young children. <b>Conclusions:</b> This case emphasizes the role of cricopharyngeal EMG in the differential diagnosis for pediatric feeding difficulties and its potential for spontaneous resolution. It highlights the need for further research into prognostic indicators and management strategies for CPA in children, offering a hopeful perspective for clinicians and caregivers.