Many patients experience the symptom of dysphagia caused by cricopharyngeal muscle spasm. This spasm is often treated with medications, bouginage, pharyngeal plexus neurectomy, and cricopharyngeal myotomy. In a number of patients, the cause of the dysphagia may be uncertain, or may be multifactorial. Other patients may have medical conditions making them poor surgical candidates. Botulinum toxin has been found to be useful in controlling muscle spasm, including lower esophageal sphincter achalasia. We have found that in a number of these patients, a percutaneous, electromyographic guided local injection of botulinum toxin may be placed into the cricopharyngeus muscle. This injection may be useful in clarifying the diagnosis and providing therapy for the cricopharyngeal spasm. Many patients experience the symptom of dysphagia caused by cricopharyngeal muscle spasm. This spasm is often treated with medications, bouginage, pharyngeal plexus neurectomy, and cricopharyngeal myotomy. In a number of patients, the cause of the dysphagia may be uncertain, or may be multifactorial. Other patients may have medical conditions making them poor surgical candidates. Botulinum toxin has been found to be useful in controlling muscle spasm, including lower esophageal sphincter achalasia. We have found that in a number of these patients, a percutaneous, electromyographic guided local injection of botulinum toxin may be placed into the cricopharyngeus muscle. This injection may be useful in clarifying the diagnosis and providing therapy for the cricopharyngeal spasm.