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

• Published in: The Laryngoscope 2023-06, Vol.133 (6), p.1349-1355
• Main Authors: Howell, Rebecca J., Ekbom, Dale, Kasperbauer, Jan, Tabangin, Meredith, Altaye, Mekibib, Wahab, Shaun, Belafsky, Peter, Allen, Jacqui, Amin, Milan, Bayan, Semirra, Cervenka, Brian, deSilva, Brad, Dion, Greg, Friedman, Aaron, Fritz, Mark, Giliberto, John Paul, Guardiani, Elizabeth, Harmon, Jeffrey, Khosla, Sid, Kim, Brandon, Kuhn, Maggie, Kwak, Paul, Ma, Yue, Madden, Lyndsay, Matrka, Laura, Mayerhoff, Ross, Piraka, Cyrus, Rosen, Clark, Wilson, Keith, Wright, Carter, Young, Vyvy, Yuen, Sonia, Postma, Greg
• Format: Article
• Language: English
• Subjects: Cohort Studies; CPMD; cricopharyngeal bar; cricopharyngeal dysfunction; cricopharyngeus muscle dysfunction; Dysphagia; Esophageal Diseases; Esophageal Sphincter, Upper; Esophagus; Female; Humans; hypopharyngeal diverticulum; Killian Jamieson; Laryngoscopy; Muscular Diseases; Otolaryngology; Pharyngeal Diseases; pharyngoesophageal dysphagia; Prospective Studies; Zenker; Zenker Diverticulum - complications; Zenker Diverticulum - surgery
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.30387

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 ed 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 This serves as the seminal work from the prospective, multicenter cohort study of all individuals enrolled in the Prospective OUtcomes of Cricopharyngeal Hypertonicity Surgery (POUCHS) Collaborative. Of the 250 persons enrolled, 85% had a Zenker diverticula (ZD), 9% had evidence of cricopharyngeus muscle dysfunction (CPMD) without diverticula and 4% had a Killian Jamieson diverticula (KJD). Patients with isolated CPMD appear to be more symptomatic than persons with ZD or KJD.