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

Rebecca J. Howell, Dale Ekbom, Jan Kasperbauer, Meredith Tabangin, Mekibib Altaye, Shaun Wahab, Peter Belafsky, Jacqui Allen, Milan Amin, Semirra Bayan, Brian Cervenka, Brad deSilva, Greg Dion, Aaron Friedman, Mark Fritz, John Paul Giliberto, Elizabeth Guardiani, Jeffrey Harmon, Sid Khosla, Brandon KimMaggie Kuhn, Paul Kwak, Yue Ma, Lyndsay Madden, Laura Matrka, Ross Mayerhoff, Cyrus Piraka, Clark Rosen, Keith Wilson, Carter Wright, Vyvy Young, Sonia Yuen, Greg Postma

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)1349-1355
Number of pages7
Issue number6
StatePublished - Jun 2023


  • CPMD
  • Killian Jamieson
  • Zenker
  • cricopharyngeal bar
  • cricopharyngeal dysfunction
  • cricopharyngeus muscle dysfunction
  • hypopharyngeal diverticulum
  • pharyngoesophageal dysphagia

ASJC Scopus subject areas

  • Otorhinolaryngology


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