You are being redirected to
The secondary peristaltic wave is induced by esophageal distension from the retained bolus, refluxed material, or swallowed air. With severe ulceration, amputation of the uvula and tip of the epiglottis may be observed radiographically. Circumferential webs appear as ringlike shelves in the cervical esophagus. Ronnie Fass, MD, FACP, FACG is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Israeli Medical AssociationDisclosure: Received grant/research funds from Takeda Pharmaceuticals for conducting research; Received consulting fee from Takeda Pharmaceuticals for consulting; Received honoraria from Takeda Pharmaceuticals for speaking and teaching; Received consulting fee from Vecta for consulting; Received consulting fee from XenoPort for consulting; Received honoraria from Eisai for speaking and teaching; Received grant/research funds from Wyeth Pharmaceuticals for conducting research; Received grant/research funds f. Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine. We put him on an oral rest for now. 2013 Jun. 57(3):683-9. Severe ulceration with subsequent scarring may also be caused by lye ingestion ( Fig. Such patients usually demonstrate normal findings on pharyngograms or evidence of nonspecific lymphoid hyperplasia of the palatine or lingual tonsils. In the peristaltic esophageal body, achalasia is characterized by a loss of intrinsic acetylcholine-containing nerves. The spectrum of these disorders ranges from the well-defined primary esophageal motility disorders (PEMDs) to very nonspecific disorders that may play a more indirect role in reflux disease and otherwise be asymptomatic. fX"cr4Fe"?zp8k$i?NrMqjnvVu^5TUfVrGMZWI/];^gAC]Hq$6)\~|ounXx2 f(E^4ikb Qh/#GH+;&*~7ka<2(
\ In 80% of patients, the cause of a patient's dysphagia can be suggested from the history, including dysmotility of the esophagus. The site is secure. Crit Rev Diagn Imaging 28:133179, 1988. HU6?Q Whether or not symptomatic relief is achieved, the prognosis in patients with spastic esophageal motility disorders is favorable. The cricopharyngeal muscle constitutes the lower portion of the inferior constrictor muscle, arising from the lateral cricoid cartilage to encircle the lowermost hypopharynx. Abdullah Fayyad, MD, MBBS is a member of the following medical societies: American Gastroenterological AssociationDisclosure: Nothing to disclose. The pathogenesis of Zenkers diverticulum is as controversial as the muscular anatomy. Inability to swallow. Many nasopharyngeal squamous cell cancers are undifferentiated tumors, and many have a reactive lymphoid stroma. Patients with internal laryngoceles may complain of hoarseness, dysphagia, or choking. The term comes from the oropharynx, the location in the back of the throat, and dysphagia, which means disordered swallowing. Partial obstruction is suggested by a jet phenomenon or by dilation of the esophagus or pharynx proximal to the web (see Fig. RadioGraphics 8:641665, 1988.). The 2 best-characterized motility disorders, achalasia and DES, represent only a small percentage of diagnosed motility disorders. Achalasia affects both sexes in equal numbers. Approximately 50% of patients develop cervical nodal metastases.
The pharyngeal outpouchings are of endodermal origin and are termed branchial pouches. Posterior tongue tie, base of tongue movement, and pharyngeal dysphagia: what is the connection?. Dis Esophagus. [QxMD MEDLINE Link]. In addition to alcohol and smoking abuse, poor ventilation, nasal balms, ingested carcinogens, and upper respiratory viruses such as the Epstein-Barr virus have been implicated as causative factors. hb```f``r Problem-Solving with Catherine: 5-year-old with Athetoid Cerebral Palsy, Problem-Solving with Catherine: Infant in NICU with HIE. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. Would you like email updates of new search results? Exophytic lesions are more common ( Fig. Neurogastroenterol Motil. In contrast, lateral pharyngeal diverticula are persistent protrusions of pharyngeal mucosa, usually through the thyrohyoid membrane or, rarely, through the tonsillar fossa. No reliable information for other motility disorders exists. The response to amyl nitrate (a smooth muscle relaxant), with partial relaxation of the lower esophageal sphincter (LES), allows some barium to pass through it into the stomach. Frontal view of the pharynx obtained as the bolus is passing through the lower pharynx and pharyngoesophageal segment. Epub 2021 Feb 5. Scintigraphy also had good sensitivity in detecting penetration and/or aspiration in VFS. The thyropharyngeal muscle arises from the lateral ala of the thyroid cartilage; it courses laterally and posteriorly to merge with its counterpart from the opposite side in a raphe in the posterior pharyngeal wall. )dC(SOL*W vRlYE1Zt[@m.)S*=V!/XZ;,3`{9WW(Kr[tfJ[XR[N{\Q*}iRf8w!fM}CS7x.03cO]Mux: T*xo~g|[IlyQV[G_W6W(=ihk- Thorac Surg Clin. Questionable dysmorphic features, we are awaiting genetic testing results. This space is bounded superiorly by the inferior margin of the cricopharyngeal muscle, anteriorly by the inferior margin of the cricoid cartilage, and inferomedially by the suspensory ligament of the esophagus originating from the posterior wall of the cricoid cartilage, just before the tendon forms the longitudinal muscle of the esophagus. list of sundown towns in new england; jeff mudgett wikipedia. Lateral Pharyngeal Pouches and Diverticula, Branchial Cleft Cysts, Branchial Cleft Fistulas, and Branchial Pouch Sinuses, Lateral Cervical Esophageal Pouches and Diverticula, Lymphoid Hyperplasia of the Lingual and Palatine Tonsils, Surgery for Tongue and Oropharyngeal Cancers, Surgery for Zenkers Diverticulum and Pharyngeal Pouches. In the 4-week-old embryo, paired grooves of ectodermal origin, termed branchial clefts, appear on both sides of the neck region. Head Neck. Eric A Gaumnitz, MD Professor of Medicine, Division of Gastroenterology, University of Wisconsin School of Medicine; Program Director, Gastroenterology and Hepatology Fellowship, University of Wisconsin School of Medicine and Public Health; Director, Motility Unit, University of Wisconsin Hospitals Carlson DA, Ravi K, Kahrilas PJ, et al. These studies are especially valuable in areas of the pharynx that are difficult to evaluate by endoscopy (e.g., lower base of the tongue, valleculae, lower hypopharynx, pharyngoesophageal segment). This is the American ICD-10-CM version of J39.2 - other international versions of ICD-10 J39.2 may differ. Squamous cell carcinomas that affect the epiglottis, aryepiglottic folds, mucosa overlying the arytenoid cartilages, false vocal cords, and laryngeal ventricles are defined as supraglottic carcinomas. Recent ECHO showed a moderate ASD. In immunosuppressed patients with acute dysphagia, barium studies are directed toward the esophagus to demonstrate the presence, site, and type of esophagitis. Has there been a neuro consult? ASHA / Pharyngeal Phase Bolus. The cause and clinical significance of webs are controversial. MeSH Most patients are asymptomatic and in the fifth to sixth decade of life. Hoarseness. Image courtesy of Andrew Taylor, MD, Professor, Abdominal Imaging, Department of Radiology, University of Wisconsin Medical School, Madison. 110(7):967-77; quiz 978. Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. The benign nature of these lesions should be confirmed by endoscopic examination. Most patients with squamous cell carcinoma are 50 to 70 years of age. If saccular dilation of the appendix is confined by the thyroid cartilage, it is termed an internal laryngocele. A lateral pharyngeal diverticulum is a protrusion of nonkeratinizing squamous mucosa originating in the pharynx. Share cases and questions with Physicians on Medscape consult. Radiographically, an exophytic lesion appears as a polypoid mass projecting into the oropharyngeal air space. Lateral view shows a smooth-surfaced hemispheric mass (, A smooth-surfaced, well-circumscribed mass (, (From Rubesin SE, Glick SN: The tailored double-contrast pharyngogram. In contrast, the neck of Zenkers diverticulum is on the posterior hypopharyngeal wall, and the sac extends inferiorly behind the cervical esophagus. Diagnostic Accuracy of an Esophageal Screening Protocol Interpreted by the Speech-Language Pathologist. coughing or choking when eating or drinking. Tumors of the epiglottis and aryepiglottic folds may also result in dysphagia, coughing, or choking because of laryngeal penetration. Depending on the rate and extent of disease progression, therapy might include endoscopic and surgical interventions. [QxMD MEDLINE Link]. endstream
endobj
224 0 obj
<>
endobj
225 0 obj
<>
endobj
226 0 obj
<>stream
Poorly differentiated tumors are frequently of the ulcerative infiltrative type and may be obscured on barium studies by the underlying nodular lymphoid tissue of the palatine tonsil. This delayed spill may result in dysphagia or a choking sensation because of overflow aspiration. What pharyngeal stage disorder is a result of reduced and / or mistimed laryngeal closure before, during, and after the swallow? Bookshelf The diverticula are lined by nonkeratinizing squamous epithelium surrounded by loose areolar connective tissue, with many vascular spaces. Associated complications, including strictures, Barrett esophagus, and adenocarcinoma of the esophagus, are the concern. 2016 Apr 30. Barium, MRI, or CT studies may be extremely helpful in detecting clinically occult lesions with nodal metastases. Only rarely is a pedunculated polypoid lesion (e.g., papilloma, fibrovascular polyp) seen. FOIA This work supports a comprehensive evaluation of both the . Disorders of esophageal motility are referred to as primary or secondary esophageal motility disorders and categorized according to their abnormal manometric patterns. However, other manometric studies have shown the following: (1) there is normal coordination between pharyngeal contraction and relaxation of the upper esophageal sphincter; (2) the upper esophageal sphincter relaxes completely during swallowing (i.e., there is no achalasia); and (3) the resting pressure of the upper esophageal sphincter is low (i.e., there is no spasm). Lymphoid hyperplasia of the base of the tongue. Because such a strong association exists between head and neck squamous cell carcinoma and esophageal carcinoma, a major goal of a preoperative radiologic study is to rule out a synchronous primary esophageal cancer. Lymphoid hyperplasia of the palatine tonsils. Chest pain is, in fact, a more common complaint that may precipitate emergency room visits and cardiologic evaluations. [QxMD MEDLINE Link]. Manometry may reveal elevated LES pressure greater than 40 mm Hg in more than 60% of patients; however, hypertensive LES is not universal or required for the manometric diagnosis. No documented abnormalities exist regarding the distribution of myenteric neurons in patients diagnosed with spastic motility disorders of the esophageal body, but diffuse fragmentation of vagal filaments, increased endoneural collagen, and mitochondrial fragmentation are described. Spastic esophageal motility disorders are associated with symptomatic discomfort but do not lead to the severity of dysphagia observed in patients with achalasia. Ectopic thyroid tissue and thyroglossal duct cysts may occur at the tongue base but are rare. Squamous cell carcinoma of the palatine tonsil is the most common malignant tumor arising in the pharynx. 16-12 ). Lateral spot image of the pharynx shows obliteration of the contour of the lower soft palate, which is replaced by a lobulated mass (, (From Rubesin SE, Rabischong P, Bilaniuk LT, etal: Contrast examination of the soft palate with cross-sectional correlation. They are usually unilateral. This association was termed Plummer-Vinson syndrome or Paterson-Kelly syndrome. Significant acid reflux might lead to disabling symptoms, caused by reflux or its complications. J39.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Search google scholar for this article by my colleague and friend, Laura Brooks, which may or may not be pertinent, pending your further assessment and refection. Aryepiglottic fold nodules or mass lesions may cause dysphonia or respiratory symptoms such as stridor. Some webs show inflammatory changes. When I read your post with such clear clinical and radiologic presentation, the possible etiologies/questions that popped in my mind as I read your post were: hypotonia (constipation, lethargy, oral-motor disintegrity understood thus far; wonder about postural control and movement patterns, sensory-moor function include trunk and head/neck), extra esophageal reflux (nasal congestion, lax pharyngeal constrictors, perhaps postural hypotonia), poor posterior driving force of tongue (often correlated with hypotonia, poor pressure generation to help achieve UES relaxation and opening, posterior tongue tie and/or mandibular hypoplasia.seems at times ENTs miss that). Benign cartilaginous tumors involving the pharynx (chondromas) usually arise from the posterior lamina of the cricoid cartilage. %%EOF
Although acute epiglottitis usually affects children between 3 and 6 years of age, it occasionally causes severe stridor and sore throat in adults. Manometry demonstrates diffuse esophageal spasm with simultaneous contractions of the esophagus observed throughout the tracing. Thanks for such a detailed history to help to consider possibilities. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. [1] As with any other chronic illness, prevalence exceeds incidence significantly. Patients with small lesions are often asymptomatic but present with enlarged cervical nodes. Oropharyngeal dysphagia is a medical condition that causes a disruption or delay in swallowing. Barium studies are contraindicated because they may exacerbate edema, triggering an episode of acute respiratory arrest. 16-18 ). The second branchial cleft cyst may extend between the internal and external carotid arteries at a level superior to their bifurcation. Frontal radiographs in patients with an external laryngocele may show an air-filled sac above and lateral to the ala of the thyroid cartilage. Elliott TR, Wu PI, Fuentealba S, et al. A wide variety of benign tumors occur in the pharynx. Lateral pharyngeal pouches are extremely common, and the frequency of their occurrence increases with age. True soft tissue tumors of the aryepiglottic folds, such as lipomas, neurofibromas, hamartomas, granular cell tumors, and oncocytomas, are rare. Esophageal dysmotility may be caused by: An ulcer, stricture, irritation, infection, inflammation, or cancer in the esophagus. van Hoeij FB, Tack JF, Pandolfino JE, et al. coordinated stasis The idea, proposed in 1992 by Gordon Baird, that certain groups of species remain unaltered for tens of millions of years, then experience an episode of rapid extinction and the formation of new species. We explored four different methods, namely, the visuoperceptual Radulovic M, Schilero GJ, Yen C, et al. Low peristaltic amplitudes normally occur at the transition zone between the striated and smooth muscle portions; however, the peristalsis is uninterrupted. Radiographic description of this phenomenon has been called presbyesophagus. J Am Coll Surg. There are no criteria based on size for differentiating nodularity of the base of the tongue because of normal lingual tonsils from that resulting from reactive lymphoid hyperplasia. The inferior constrictor muscle is composed of the thyropharyngeal and cricopharyngeal muscles. Schlottmann F, Patti MG. Primary esophageal motility disorders: beyond achalasia. Zenkers diverticulum (posterior hypopharyngeal diverticulum) is an acquired mucosal herniation through an area of anatomic weakness in the region of the cricopharyngeal muscle (Killians dehiscence). External and internal laryngoceles do not fill with barium on pharyngograms. HHS Vulnerability Disclosure, Help The review of VFSSs was used to confirm whether swallowing with head rotation was effective for dysphagia caused by cervical osteophytes. Four outpouchings from the pharynx grow to meet the branchial clefts. An ulcerated lesion appears as an irregular barium collection disrupting the expected contour of the base of the tongue. Computed tomography (CT) and MRI may occasionally reveal lesions (typically submucosal masses) that are not visible, even with modern endoscopes. Future research should focus on identifying symptom profiles that could lead . Praveen K Roy, MD, MSc is a member of the following medical societies: Alaska State Medical Association, American Gastroenterological AssociationDisclosure: Nothing to disclose. Gastroenterology. Complications of botulinum toxin injections for treatment of esophageal motility disorders. Achalasia is the best defined primary motility disorder and the only one with an established pathology. On frontal views, pouches appear as small, round, or ovoid protrusions of the lateral upper esophageal wall that are filled late during swallowing and that empty after swallowing. Lymph node metastases are seen ipsilaterally or contralaterally in more than 70% of patients. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features Press Copyright Contact us Creators . [QxMD MEDLINE Link]. 16-7 ) and do not empty as quickly after swallowing. [4] Features of esophagealmotilityafter endoscopic sclerotherapy are a defective lower sphincter and defective and hypotensive peristalsis. This resembles punctuated equilibrium acting at the level of communities and may occur because the species interact so closely they cannot evolve, instead responding to . The 5-year survival rate is approximately 40%. Hoarseness occurs primarily in patients with laryngeal carcinoma, supraglottic carcinoma, or carcinoma of the medial piriform sinus infiltrating the arytenoid cartilage or cricoarytenoid joint. An esophagram demonstrating the corkscrew esophagus picture observed in a patient with manometry confirmed findings of diffuse esophageal spasm (DES). Measurement of Pharyngeal Residue From Lateral View Videofluoroscopic Images Catriona M. Steele,a,b Melanie Peladeau-Pigeon,a Ahmed Nagy,a,c,d and Ashley A. Waitoa Purpose: The field lacks consensus about preferred metrics for capturing pharyngeal residue on videofluoroscopy. Philadelphia, WB Saunders, 1992. 16-8 ). Epub 2014 Jul 7. Killian-Jamieson diverticula can be bilateral or unilateral. cess. [2]. 16-16 and 16-17 ). The most common branchial vestige is a cyst arising from the second branchial cleft. This barium, trapped between downwardly progressing pharyngeal contraction and the cricopharyngeal muscle, is termed a pseudo-Zenkers diverticulum ( Fig. Before Signs and symptoms associated with dysphagia can include: Pain while swallowing. The pathophysiology of the primary esophageal motility disorders is poorly defined, with the exception of achalasia. Anteriorly, there is the larynx, epiglottis, and posterior part of the tongue. Webs are thin mucosal folds usually located along the anterior wall of the lower hypopharynx and proximal cervical esophagus. Pacifier dips in a secure swaddle elevated side lying position would allow for purposeful swallows and motor learning yet reduce risk for airway invasion, given that etiology is not fully clear. MRI brain? Achalasia is a progressive disease that requires chronic therapy. The underlying cause of all the primary motility disorders remains elusive. what is pharyngeal stasislack of education leads to violence what is pharyngeal stasis. The incidence of achalasia is 1-3 case per 100,000 population per year. Nonperistaltic isolated contractions or low-amplitude simultaneous contractions of the esophageal body may be observed. Patients with pharyngeal symptoms or a palpable neck mass may undergo pharyngoesophagography as the initial diagnostic examination. The 2023 edition of ICD-10-CM J39.2 became effective on October 1, 2022. On lateral radiographs, the base of the tongue may seem to protrude posteriorly. Symptoms attributed to lymphoid hyperplasia of the lingual tonsil include throat discomfort, a globus sensation, and dysphagia. It carries air, food and fluid down from the nose and mouth. Epub 2021 Feb 20. Dysphagia. 2009 Jun. 16-9 ). World J Gastroenterol. [QxMD MEDLINE Link].
What causes VPI? The pharynx, usually called the throat, is part of the respiratory system and digestive system. "When the results of the oropharyngeal exam and the esophagram were combined, esophageal stasis in isolation was the most common finding at all complaint locations, with the exception of patients who complained of stasis in the cervical and thoracic esophagus where the most common finding was no stasis." "Pharyngeal stasis in isolation . [QxMD MEDLINE Link]. However, in the setting of a normal MRI with normal motor development, other etiologies need to be explored. However, double-contrast examination of the pharynx may demonstrate the plaques of Candida pharyngitis or the ulcers of herpes pharyngitis, particularly in patients with AIDS ( Fig. If infected, the wall of the branchial cleft cyst becomes thickened and may enhance with the administration of intravenous contrast medium. divina peruvian pepper jam; haverhill high school yearbooks; bluey stuffed animal disney store; introduction to environmental engineering and science 3rd edition ebook Barium studies are used primarily to evaluate the symptoms of nasal regurgitation and voice changes caused by soft palate insufficiency and to rule out a synchronous esophageal tumor. The neck of the Zenkers diverticulum can be very broad during swallowing. Wondering about work of breathing, swallow-breathe interface with both pacifier dips and/or clinical observation of PO feeding. The second branchial cleft forms the middle ear, eustachian tube, and floor of the tonsillar fossa. Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. Herbella FA, Colleoni R, Bot L, Vicentine FP, Patti MG. High-resolution manometry findings in patients after sclerotherapy for esophageal varices. The symptoms of pharyngeal carcinoma are nonspecific and usually of short duration (<4 months). Disruption of this highly integrated muscular motion limits delivery of food and fluid, as well as causes a bothersome sense of dysphagia and chest pain. Cross-sectional imaging of noninfected cysts may reveal a smooth, thin-walled mass with a homogeneous water core. Benign tumors arising from the minor mucoserous salivary glands are usually seen in the oropharynx in the region of the soft palate and base of the tongue. OT consult? This work supports a comprehensive evaluation of both the pharynx and the esophagus for patients with complaints of bolus stasis in the throat. In some patients, this regurgitation of barium results in overflow aspiration. The risk factors, age of presentation, and histologic type are more varied than those of the typical squamous cell carcinoma of the oropharynx and hypopharynx. Physiologic characteristics of achalasia are additionally useful in assisting with establishing the diagnosis through chemical challenge testing. 245 0 obj
<>stream
Barium studies reveal the size, extent, and inferior limit of pharyngeal tumors and the degree of functional impairment. Whether gastroesophageal reflux predisposes patients with a large Killian dehiscence to the formation of Zenkers diverticulum is unknown. In lymphoid hyperplasia of the palatine tonsils, masslike enlargement of the palatine tonsils is seen in the frontal and lateral views ( Fig. Bethesda, MD 20894, Web Policies 2009 Apr. 2015 Jul. These tumors infiltrate deeply into the intrinsic and extrinsic muscles of the tongue. An intraluminal mass may be manifested radiographically by obliteration of the normal luminal contour, extra barium-coated lines protruding into the expected pharyngeal air column, a focal area of increased radiopacity, or a filling defect in the barium pool. Frontal view shows large, smooth-surfaced, round to ovoid nodules (. 16-11 ). Results Dysphagia evaluation was completed in 301 patients with complaints of bolus stasis. 16-6 ). Conclusion Patients are poor at localizing bolus stasis, and esophageal stasis is common in patients who complain of pharyngeal stasis. The LES pressure tracing is at the level of the sleeve (tracing 6). The third and fourth branchial pouches form the piriform sinuses. Increased incidence of both esophageal squamous cell and adenocarcinoma is observed in patients with long-standing achalasia. However, no studies to date have shown convincing evidence that surveillance is worthwhile. endstream
endobj
startxref
Motility is preserved at the proximal striated muscle portion of the esophagus. %PDF-1.6
%
The webs protrude to various depths into the esophageal lumen. At rest, the barium-filled diverticulum extends below the level of the cricopharyngeal muscle posterior to the proximal cervical esophagus ( Fig. Dysphagia. Inflammatory disorders of the pharynx or gastroesophageal reflux can alter pharyngeal elevation, epiglottic tilt, or closure of the vocal cords and laryngeal vestibule. Food coming back up (regurgitation) Frequent heartburn. Deciphering Oral Stasis: Managing the Challenging Combination of Dementia and Dysphagia - Part I Presenter: Michelle Tristani, M.S., CCC-SLP Moderated by: Amy Natho, M.S., CCC-SLP, CEU Administrator, SpeechPathology.com 1 . This site needs JavaScript to work properly. gopuff warehouse address; barts health nhs trust canary wharf; Extrinsic nerves may also be affected, characterized by Wallerian degeneration of the axoplasm and myelin sheaths within the vagus nerve and dorsal motor nucleus. Muscles of the oral cavity, pharynx, and cervical esophagus are of the striated variety. This can cause speech that is difficult to understand. [High-resolution manometry of pharyngeal swallowing dynamics]. Lateral view of the pharynx shows well-circumscribed plaques (. Achalasia manometry picture Note the nonrelaxing lower esophageal sphincter (LES) and the absence of esophageal body peristalsis. 12:CD005046. These vallecular and piriform sinus webs are composed of mucosa, lamina propria, and underlying blood vessels. 16-7 ). Neurological disorders aff Radiographic findings in pharyngeal carcinoma. Barium studies allow detection of more than 95% of structural lesions below the pharyngoesophageal fold. Familial clustering is observed, but a genetic relationship is not established. [QxMD MEDLINE Link]. Racial and environmental differences in the incidence of achalasia and other esophageal motility disorders might be present; however, because of the low incidence of disease and underdiagnosis in developing countries, these differences have not been demonstrated. These pouches and diverticula are relatively common and may be confused radiographically with Zenkers diverticulum. The 5-year survival rate varies from 76% for patients with localized tumors to 10% to 20% for patients with cervical lymph node metastases. A referred earache may occur, especially when nasopharyngeal tumors block the eustachian tube.