title: Pharyngeal stasis of secretions in patients with Zenker diverticulum.
abstract: 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.
  
  
  METHODS
  A case-control study.
  
  
  METHODS
  A subspecialty swallowing clinic.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Baylor College of Medicine, Houston, Texas 77030, USA. julinao@bcm.edu
authors.forename: Julina
authors.initials: J
authors.lastname: Ongkasuwan
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Yung
authors.forename: Mark S
authors.initials: MS
authors.lastname: Courey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016001:Confidence Intervals; D003680:Deglutition Disorders / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010614:Pharynx / Q000378:metabolism*; D011237:Predictive Value of Tests; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017792:Surgical Stapling / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D016672:Zenker Diverticulum / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*