Pharyngeal stasis of secretions in patients with Zenker diverticulum

Otolaryngol Head Neck Surg. 2012 Mar;146(3):426-9. doi: 10.1177/0194599811430048. Epub 2011 Dec 13.


Objective: To determine whether patients with Zenker diverticulum are more likely to have stasis of secretions in the left piriform sinus, on in-office endoscopy, than patients with nonspecific dysphagia.

Study design: A case-control study.

Setting: A subspecialty swallowing clinic.

Subjects and methods: All patients with radiographically confirmed Zenker diverticulum who were evaluated over a 5-year period were selected. A control group with dysphagia due to radiographically confirmed esophageal dysmotility, prominent cricopharyngeal bar, or stricture was identified. Two blinded laryngologists reviewed the recorded laryngopharyngoscopies.

Results: Thirty-four patients with Zenker diverticulum were identified; 11 were excluded because of previous surgery or other neurological conditions. Twelve (52.17%) of the remaining 23 Zenker diverticulum patients and 2 of the 73 (2.74%) control patients had greater pooling in the left versus right piriform sinus (2-tailed t test, P < .0001). The sensitivity of this physical examination finding in identifying patients with Zenker diverticulum was 52.17% (95% confidence interval, 31.08%-72.58%) and specificity was 97.26% (95% confidence interval, 89.56-99.52%). Patients with Zenker diverticulum less than 4 cm in size had increased pooling in the left versus right piriform compared with larger diverticulums. After surgical intervention, there was a statistically significant decrease in the asymmetrical pooling (2-tailed t test, P = .0067).

Conclusion: Increased pooling in the left compared with the right piriform, on in-office endoscopy, is predictive of the presence of a Zenker diverticulum. This information can sharpen clinical acumen in evaluating patients with dysphagia. In turn, it will help the clinician counsel the patient regarding diagnosis and radiographic imaging.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Confidence Intervals
  • Deglutition Disorders / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Laryngoscopy / methods*
  • Male
  • Middle Aged
  • Observer Variation
  • Pharynx / metabolism*
  • Predictive Value of Tests
  • Radiography
  • Reference Values
  • Retrospective Studies
  • Severity of Illness Index
  • Surgical Stapling / methods
  • Time Factors
  • Treatment Outcome
  • Zenker Diverticulum / diagnostic imaging
  • Zenker Diverticulum / physiopathology
  • Zenker Diverticulum / surgery*