Lateral laryngopharyngeal diverticula: a videofluoroscopic study of laryngopharyngeal wall in wind instrumentalists

Abstract

<jats:p>CONTEXT: This paper analyze healthy musicians who play wind instruments. OBJECTIVE: To identify possible diverticular formations on the laryngopharyngeal wall produced by pharyngeal overpressure during the use of these instruments. METHODS: Through a videofluoroscopic method, 22 professional musicians had their pharynx analyzed in frontal face and profile, by swallowing 20 mL of barium sulfate solution and blowing against resistance. RESULTS: All the volunteers showed lateral laryngopharyngeal diverticula (3 unilateral and 19 bilateral) with areas ranging from 0.7 to 6 cm². Trumpet and clarinet players showed larger diverticula, on both the right and left sides. Any important complaints were noted spontaneously or after questions. In the barium-swallow analyses, the 41 diverticula previously identified in the blowing tests were not seen or appeared to be smaller, because of the free flux passage from the pharynx to the esophagus. Despite the existence of the other, less resistant areas on the laryngopharyngeal segment, no other protrusions could be found in this group of wind instrumentalists. CONCLUSIONS: The lateral laryngopharyngeal diverticula that occur in blow instrumentalists is distinct of diverticula produced by laryngopharyngeal overpressure determined by abnormally high resistance to flux passage from pharynx to esophagus. In musicians is the persistent and continuous pharyngeal overpressure induced by the resistance of the instrument's mouthpiece will strongly distend the anatomically less resistant areas of the pharynx, producing a large protrusion. Laryngopharyngeal overpressure without abnormal resistance to flux passage explain the way blow instrumentalists protrusions did not appear as full sacs in a barium-swallow test, despite their larger dimensions. As final conclusion the musician-acquired diverticula must be considered as an "occupational overuse syndrome".</jats:p>

Dysphagia and Sialorrhea:

“…These diverticula are considered to result from pharyngeal overpressure, which is often produced by dysphagia (4,5,7) . Their presence in the PD patients indicates a long-term pharyngeal pressure overcharge.…”

“…Their presence in the PD patients indicates a long-term pharyngeal pressure overcharge. These kind of diverticula usually do not present symptoms (4,5,7) .…”

Voz e trato vocal de instrumentistas de sopro: Revisão integrativa da literatura

“…Em relação aos delineamentos, dos sete estudos analisados, foram encontradas cinco pesquisas de delineamento transversal 2,5,10,12,13 , um estudo de caso 11 e uma revisão de literatura 6. No que diz respeito aos métodos utilizados para a realização das pesquisas, foram empregados diferentes instrumentos de avaliação clínica e instrumental, entre eles: a videolaringoscopia 5, 11 , questionários 2,5,10,11 , análise perceptivo auditiva da voz 2,13 , análise acústica do sinal vocal 13 e a videofluoroscopia 12.…”

Novel endoscopic treatment of pharyngocele: Endoscopic suture pharyngoplasty

“…The differential diagnosis should include Zenker's diverticulum, laryngocele, esophageal diverticulum, an artificial pouch, cricopharyngeal spasm, foreign body, neurologic disorders, myopathies, and globus hystericus. Also, a normal small outpouching of the lateral pharyngeal wall must be differentiated from the LPD . This small outpouching can be seen in many patients during the Valsalva maneuver.…”