This disease is relatively common and is frequently seen in wind instrument players and the elderly.

bubble_chart Etiology

The cause of the disease is unknown and may be related to the following factors: ① Congenital factors: The thyrohyoid membrane area is the opening of the third pharyngeal pouch. Some believe that lateral wall diverticula are extensions of the third or fourth pharyngeal pouch, but others disagree. ② Theory of increased intrapharyngeal pressure: It is thought to be related to dysfunction of the cricopharyngeal muscle and esophagus, as well as increased intrapharyngeal pressure. ③ Age-related weakening of the pharyngeal wall: Seaman noted that such diverticula often occur in the elderly and are considered a normal phenomenon. The diverticula open in the pharynx at the tonsillar fossa, epiglottic vallecula, and pyriform sinus, sometimes appearing as multiple occurrences. The most common type is formed by the protrusion of the pharyngeal mucosa through the thyrohyoid membrane on the anterolateral wall of the pyriform sinus, which lies in the same plane as the epiglottic vallecula. The thyrohyoid membrane lacks cartilage or bone support, and the middle and inferior pharyngeal constrictor muscles do not fully cover it. The superior laryngeal vessels and nerves pass through this area. Once the diverticulum forms, the weight of its contents can cause it to gradually enlarge.

bubble_chart Clinical Manifestations

Depending on the size and location of the diverticulum, small diverticula may be asymptomatic. Due to the presence of the diverticulum, symptoms such as fetid mouth odor, a sensation of pharyngeal obstruction, foreign body sensation, and food reflux may occur. Larger diverticula can cause dysphagia and hoarseness. Physical examination may reveal small openings in the tonsillar fossa, vallecula, or pyriform sinus, and sometimes a probe can be inserted into the diverticulum. A mass that expands and contracts with air pressure may be palpable in the neck. Alternatively, when pinching the nose and blowing air, a soft cystic mass may appear on the lateral neck wall, with tympanic resonance or fluctuation, which can be reduced by pressure, accompanied by a gurgling sound or liquid spilling from the mouth.

The diagnosis can be made based on medical history and clinical manifestations. Diverticulum inflation, barium swallow, or barium-air contrast can confirm the diagnosis. Esophagoscopy can identify the diverticulum opening and allows for conservative surgical intervention.

bubble_chart Treatment Measures

Asymptomatic lateral pharyngeal diverticula may not require treatment. For pharyngeal diverticula caused by forceful blowing, symptoms can resolve once the action is stopped and the diverticulum shrinks. Small diverticula with mild symptoms can be managed conservatively, such as through diverticulum irrigation. For those with significant symptoms or larger diverticula, surgical treatment may be necessary, such as enlarging the diverticulum opening or excising the diverticulum and suturing the base.