Pharyngeal Pooling in Patients with Zenker’s Diverticulum

Abstract

Objective: Determine if patients with a diagnosis of Zenker diverticulum are more likely to have pooling of secretions in the left piriform sinus on in-office endoscopy compared with patients with non specific dysphagia without motion abnormality or known neurologic disorder. Method: A retrospective review was performed of patients evaluated at a subspecialty swallowing clinic, over a 5-year period, with radiographically confirmed Zenker's diverticulum. A control group with dysphagia due to radiographically confirmed esophageal dysmotility, prominent cricopharyngeal bar, or stricture was identified. Two blinded laryngologists reviewed the recorded laryngoscopies. Results: A total of 29 Zenker patients were identified; 7 were excluded due to previous surgery. Of the 22 remaining patients, the mean age was 68.45 years (range, 26-95 years). Fourteen (59.09%) of the Zenker diverticulum patients had greater pooling in the left versus right piriform sinus. The average age of the 16 control patients was 61.31 years (range, 18-84 years). One of the 16 (6.25%) had greater pooling in the left piriform (2-tailed t test, P < less than .0005). While the sensitivity of this physical examination finding in identifying patients with Zenker diverticulum is 60.09%, specificity is 93.75% and the positive predictive value is 92.86%. Conclusion: Increased pooling in the left compared with the right piriform, on in-office endoscopy, is significantly associated with 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.