TY - JOUR
T1 - Pharyngeal stasis of secretions in patients with zenker diverticulum
AU - Ongkasuwan, Julina
AU - Yung, Katherine C.
AU - Courey, Mark S.
PY - 2012/3
Y1 - 2012/3
N2 - 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.
AB - 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.
KW - Dysphagia
KW - Laryngology
KW - Swallowing
KW - Zenker diverticulum
UR - http://www.scopus.com/inward/record.url?scp=84858809310&partnerID=8YFLogxK
U2 - 10.1177/0194599811430048
DO - 10.1177/0194599811430048
M3 - Article
C2 - 22166966
AN - SCOPUS:84858809310
SN - 0194-5998
VL - 146
SP - 426
EP - 429
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 3
ER -