Voice Outcomes in Surgical Repair of Zenker's Diverticulum

Abstract

The purpose of the study was to define the impact of Zenker's diverticula on voice and potential benefit from repair. Retrospective chart review of prospectively collected data from eleven patients with a Zenker's diverticulum treated surgically in a tertiary care center from November 2014 through January 2016. The voice handicap index-10 (VHI-10) and eating assessment tool-10 (EAT-10) questionnaires were collected as part of pre- and post-operative evaluation, with an average post-operative follow-up of 69 days. Surgical techniques included: trans-oral endoscopic diverticulotomy with laser assistance, or trans-cervical approach with diverticulopexy or diverticulectomy. The primary outcome was subjective voice improvement. Secondary outcome was swallowing function improvement. Statistical analysis was performed using Wilcoxon Signed-Ranks and Mann-Whitney U tests. In patients undergoing surgical treatment of Zenker's diverticula, there is a statistically significant improvement (p = 0.001) in patient-reported dysphagia symptoms measured by the EAT-10. There is also a clinically relevant improvement in subjective voice quality (average pre-operative total 6.55, post-operative 2.09, p = 0.022) as measured by the VHI-10. Many patients suffering from Zenker's diverticula experience subjective voice handicap. Most note improvement in voice quality post-operatively, which we were able to quantify using the voice handicap index. We consider this a relevant consideration in pre-operative evaluation.

Keywords: Dysphagia; Dysphonia; Surgical outcomes; Voice handicap index; Zenker’s diverticulum.