Diagnosis of lateral hypopharyngeal pouches: a comparative study of videofluorography and pseudovalsalva maneuver in double contrast pharyngography

Abstract

Background: To evaluate the difference between the pseudovalsalva maneuver in double-contrast pharyngography and the videofluorographic swallowing examination in the detection and grading of lateral hypopharyngeal pouches.

Methods: Two hundred twenty-seven videofluorographic swallowing examinations and double-contrast pharyngography using the pseudovalsalva maneuver were retrospectively analyzed by two radiologists. The mean age of the patients was 54 years (range = 21–81 years). The examination was performed on a fluoroscopy unit with a U-matic videorecording system in standard projections. Iodinated contrast agent was used, followed by barium if there was no massive aspiration.

Results: In contrast to the videofluorographic swallowing examination, which showed 170 lateral hypopharyngeal pouches (113 grade I, 39 grade II, 18 grade III) in 101 patients, the pseudovalsalva maneuver showed 304 pouches (304 grade III) in 179 patients. No videofluorographically diagnosed lateral hypopharyngeal pouches were missed by the pseudovalsalva maneuver; 134 pouches in 78 patients diagnosed with pseudovalsalva maneuver had no correlation videofluorographically.

Conclusion: Double-contrast pharyngography using the pseudovalsalva maneuver is not a reliable method for the diagnosis of lateral hypopharyngeal pouches.