Cricopharyngeus Muscle Dysfunction and Hypopharyngeal Diverticula (e.g., Zenker): A Multicenter Study

Rebecca J Howell¹, Dale Ekbom², Jan Kasperbauer², Meredith Tabangin³, Mekibib Altaye³, Shaun Wahab⁴, Peter Belafsky⁵, Jacqui Allen⁶, Milan Amin⁷, Semirra Bayan², Brian Cervenka¹, Brad deSilva⁸, Greg Dion⁹, Aaron Friedman¹, Mark Fritz¹⁰, John Paul Giliberto¹¹, Elizabeth Guardiani¹², Jeffrey Harmon¹, Sid Khosla¹, Brandon Kim⁸, Maggie Kuhn⁷, Paul Kwak⁶, Yue Ma¹³, Lyndsay Madden¹⁴, Laura Matrka⁸, Ross Mayerhoff¹⁵, Cyrus Piraka¹⁶, Clark Rosen¹³, Keith Wilson¹, Carter Wright¹⁴, Vyvy Young⁷, Sonia Yuen¹, Greg Postma¹⁷

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.
² Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
³ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
⁴ Department of Radiology, University of Cincinnati, Cincinnati, Ohio, U.S.A.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Davis, California, U.S.A.
⁶ Department of Surgery, University of Auckland, Auckland, New Zealand.
⁷ Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, U.S.A.
⁸ Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A.
⁹ Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁶ Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, U.S.A.

PMID: 36102298
DOI: 10.1002/lary.30387

Multicenter Study

Cricopharyngeus Muscle Dysfunction and Hypopharyngeal Diverticula (e.g., Zenker): A Multicenter Study

Rebecca J Howell et al. Laryngoscope. 2023 Jun.

. 2023 Jun;133(6):1349-1355.

doi: 10.1002/lary.30387. Epub 2022 Sep 14.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A.
² Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
³ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
⁴ Department of Radiology, University of Cincinnati, Cincinnati, Ohio, U.S.A.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Davis, California, U.S.A.
⁶ Department of Surgery, University of Auckland, Auckland, New Zealand.
⁷ Department of Otolaryngology-Head and Neck Surgery, New York University, New York, New York, U.S.A.
⁸ Department of Otolaryngology-Head and Neck Surgery, Ohio State University, Columbus, Ohio, U.S.A.
⁹ Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, U.S.A.
¹³ Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A.
¹⁴ Department of Otolaryngology-Head and Neck Surgery, Wake Forest University, Winston-Salem, North Carolina, U.S.A.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁶ Department of Gastroenterology/Hepatology, Henry Ford Health System, Detroit, Michigan, U.S.A.
¹⁷ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University Health, Augusta, Georgia, U.S.A.

PMID: 36102298
DOI: 10.1002/lary.30387

Abstract

Objective: To describe demographics and imaging and compare findings and symptoms at presentation in a large cohort of persons with cricopharyngeus muscle dysfunction (CPMD) with and without hypopharyngeal diverticula.

Methodology: Prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeal Hypertonicity (POUCH) Collaborative. Patient survey, comorbidities, radiography, laryngoscopy findings, and patient-reported outcome measures (e.g., Eating Assessment Tool [EAT-10]) data were abstracted from a REDCap database and summarized using means, medians, percentages, and frequencies. Diagnostic categories were compared using analysis of variance.

Results: A total of 250 persons were included. The mean age (standard deviation [SD]) of the cohort was 69.0 (11.2). Forty-two percent identified as female. Zenker diverticula (ZD) was diagnosed in 85.2%, 9.2% with CPMD without diverticula, 4.4% with a Killian Jamieson diverticula (KJD), and 1.2% traction-type diverticula. There were no differences between diagnostic categories in regard to age, gender, and duration of symptoms (p = 0.25, 0.19, 0.45). The mean (SD) EAT-10 score for each group was 17.1 (10.1) for ZD, 20.2 (9.3) for CPMD, and 10.3 (9.4) for KJD. Patients with isolated CPMD had significantly greater EAT-10 scores compared to the other diagnostic groups (p = 0.03).

Conclusion: ZD is the most common, followed by CPMD without diverticula, KJD, and traction-type. Patients with isolated obstructing CPMD may be more symptomatic than persons with ZD or KJD.

Level of evidence: 4 Laryngoscope, 133:1349-1355, 2023.

Keywords: CPMD; Killian Jamieson; Zenker; cricopharyngeal bar; cricopharyngeal dysfunction; cricopharyngeus muscle dysfunction; hypopharyngeal diverticulum; pharyngoesophageal dysphagia.

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References

BIBLIOGRAPHY

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Cricopharyngeus Muscle Dysfunction and Hypopharyngeal Diverticula (e.g., Zenker): A Multicenter Study

Affiliations

Cricopharyngeus Muscle Dysfunction and Hypopharyngeal Diverticula (e.g., Zenker): A Multicenter Study

Authors

Affiliations

Abstract

References

BIBLIOGRAPHY

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials