Improvement in the Reflux Symptom Index Following Surgery for Cricopharyngeal Dysfunction



      Gastroesophageal reflux may contribute to the development of cricopharyngeal dysfunction and Zenker's diverticulum. Common dictum suggests that if upper esophageal sphincter tone is reduced through cricopharyngeal myotomy, symptoms of laryngopharyngeal reflux may worsen. We hypothesized that patients who undergo myotomy should show decreased dysphagia symptoms with concurrent worsening of reflux symptomatology and that these changes would be greater in those patients undergoing complete versus partial myotomy.


      A retrospective chart review was performed for patients who underwent endoscopic or open cricopharyngeal myotomy, with or without Zenker's diverticulectomy. Preoperative and postoperative reflux symptomatology was subjectively measured with the Reflux Symptom Index (RSI), and dysphagia symptomatology was measured with the Eating Assessment Tool 10 (EAT-10). Patients who underwent partial myotomy via endoscopic stapling of Zenker's diverticulum were compared with patients who underwent complete myotomy (either endoscopic laser-assisted or via an open transcervical approach). The patients were further subdivided into three groups for data analysis: endoscopic staple diverticulotomy, laser cricopharyngeal myotomy, and open approach.


      A total of 41 patient charts were reviewed. Of these 41 patients, 17 underwent endoscopic stapler-assisted diverticulotomy, 4 underwent endosopic laser-assisted cricopharyngeal myotomy, and 20 underwent open transcervical cricopharyngeal myotomy, with diverticulectomy as indicated. Mean pre- and postoperative RSIs were 21.8 and 8.9, respectively (P < 0.001). Mean pre- and postoperative EAT-10 scores were 19.1 and 5.0, respectively (P < 0.001).


      Patients' reflux symptoms significantly improved after cricopharyngeal myotomy, with significant improvement in dysphagia symptoms. Concern for worsening of reflux symptoms following surgery does not appear to be clinically common.

      Key Words

      To read this article in full you will need to make a payment


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Witterick I.J.
        • Gullane P.J.
        • Yeung E.
        Outcome analysis of Zenker's diverticulectomy and cricopharyngeal myotomy.
        Head Neck. 1995; 17: 382-388
        • Jaramillo M.J.
        • McLay K.A.
        • McAteer D.
        Long-term clinicoradiological assessment of endoscopic stapling of pharyngeal pouch: a series of cases.
        J Laryngol Otol. 2001; 115: 462-466
        • Ong C.C.
        • Elton P.G.
        • Mitchell D.
        Pharyngeal pouch endoscopic stapling—are post-operative barium swallow radiographs of any value?.
        J Laryngol Otol. 1999; 113: 233-236
        • Verdonck J.
        • Morton R.P.
        Systematic review on treatment of Zenker's diverticulum.
        Eur Arch Otorhinolaryngol. 2014;
        • Pollei T.R.
        • Hinni M.L.
        • Hayden R.E.
        • et al.
        Comparison of carbon dioxide laser-assisted versus stapler-assisted endoscopic cricopharyngeal myotomy.
        Ann Otol Rhinol Laryngol. 2013; 122: 568-574
        • Veenker E.A.
        • Andersen P.E.
        • Cohen J.I.
        Cricopharyngeal spasm and Zenker's diverticulum.
        Head Neck. 2003; 25: 681-694
        • Belafsky P.C.
        • Postma G.N.
        • Koufman J.A.
        Validity and reliability of the Reflux Symptom Index (RSI).
        J Voice. 2002; 16: 274-277
        • Peters J.H.
        • DeMeester T.R.
        Surgery for esophageal motor disorders.
        in: Castell D.O. The Esophagus. Raven Press, Boston, MA1993: 395-434
        • Bokstein F.
        • Korczyn A.D.
        Gastrointestinal manifestations of muscle disease.
        in: Quigley E.M.M. Pfeiffer R.F. Neuro-Gastroenterology. Elsevier, Philadelphia, PA2004: 125
        • Belafsky P.C.
        • Mouadeb D.A.
        • Rees C.J.
        • et al.
        Validity and reliability of the Eating Assessment Tool (EAT-10).
        Ann Otol Rhinol Laryngol. 2008; 117: 919-924
        • Dale O.T.
        • Mackeith S.
        • Burgess C.A.
        • et al.
        Functional outcomes following endoscopic laser cricopharyngeal myotomy with mucosal repair.
        Eur Arch Otorhinolaryngol. 2014; 271: 1631-1634
        • Williams R.B.H.
        • Ali G.N.
        • Hunt D.R.
        • et al.
        Cricopharyngeal myotomy does not increase the risk of esophagopharyngeal acid regurgitation.
        Am J Gastroenterol. 1999; 94
        • Park K.H.
        • Choi S.M.
        • Kwon S.U.
        • et al.
        Diagnosis of laryngopharyngeal reflux among globus patients.
        Otolaryngol Head Neck Surg. 2006; 134: 81-85
        • Oyer S.L.
        • Anderson L.C.
        • Halum S.L.
        Influence of anxiety and depression on the predictive value of the Reflux Symptom Index.
        Ann Otol Rhinol Laryngol. 2009; 118: 687-692
        • Friedman M.
        • Hamilton C.
        • Samuelson C.G.
        • et al.
        The value of routine pH monitoring in the diagnosis and treatment of laryngopharyngeal reflux.
        Otolaryngol Head Neck Surg. 2012; 146: 952-958