top of page

BackTable / ENT / Podcast / Episode #99

Management of Zenker’s Diverticula

with Dr. Rebecca Howell

In this episode of BackTable ENT, Dr. Ashley Agan interviews Dr. Rebecca Howell, division chief of laryngology at University of Cincinnati, about her diagnosis and management of Zenker’s diverticulum.

Sponsored by:

Cook Medical Otolaryngology

Be part of the conversation. Put your sponsored messaging on this episode. Learn how.

Management of Zenker’s Diverticula with Dr. Rebecca Howell on the BackTable ENT Podcast)
Ep 99 Management of Zenker’s Diverticula with Dr. Rebecca Howell
00:00 / 01:04

BackTable, LLC (Producer). (2023, March 28). Ep. 99 – Management of Zenker’s Diverticula [Audio podcast]. Retrieved from

Free CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs. Follow the button below to claim your credits on CMEfy.

BackTable CMEfy button

Stay Up To Date



Sign Up:

Podcast Contributors

Dr. Rebecca Howell discusses Management of Zenker’s Diverticula on the BackTable 99 Podcast

Dr. Rebecca Howell

Dr. Rebecca Howell is the division chief of laryngology at University of Cincinnati in Ohio.

Dr. Ashley Agan discusses Management of Zenker’s Diverticula on the BackTable 99 Podcast

Dr. Ashley Agan

Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.

Show Notes

First, Dr. Howell explains that Zenker’s diverticulum (ZD) is a swallowing disorder caused by abnormal outpouching in the esophagus. ZD is only a herniation of the mucosal layers instead of all three tissue layers, so it is classified as a false diverticulum. To have a diagnosis of ZD, patients must have evidence of cricopharyngeus muscle dysfunction and congenital dehiscence. Oftentimes, these patients are in their seventh decade of life and will have problems with regurgitation. Dr. Howell also explains how to distinguish ZD from other differential diagnoses such as pure cricopharyngeus muscle dysfunction and nutcracker esophagus. She notes that a typical ZD patient will have a “rising tide”, or the ability to elicit frothy secretions as they talk.

Next, the doctors discuss different surveys used to diagnose and assess ZD severity. Dr. Howell also speaks about her current prospective study to determine risk factors and prognosticators of ZD. She explains that in general, men and women are affected evenly by this condition and that endoscopy has allowed the earlier diagnosis of ZD patients. Some important factors she always asks while history taking are: previous surgeries, the patient’s motivation for pursuing surgery, and the presence of neurologic diseases. Next, the doctors discuss different imaging modalities like flexible endoscopy, barium swallow studies, EGD, and manometry. Dr. Howell sees lots of potential in the field to develop and standardize workup for ZD diagnosis. While analyzing imaging studies, she also looks for concurrent diagnoses, such as paraesophageal hernia and hiatal hernia.

Then, Dr. Howell discusses how she counsels patients about treatment options for ZD. She frames ZD as a quality of life issue instead of a necessary surgery for everyone. If her patient does not choose to pursue surgery, she makes sure that they are aware of future red flags, such as pneumonia hospitalization and unintentional weight loss. The doctors also weigh the pros and cons of using an endoscopic versus open surgical approach. Based on Dr. Howell’s studies, there is no difference between both approaches, so surgeons should choose the method they prefer more. She summarizes her endoscopic technique, including her list of equipment and how she collaborates with anesthesia providers. Finally, she summarizes her postoperative care regimen and explains how she deals with leaks, an uncommon but serious complication of ZD surgery.

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Become a BackTable Sponsor

Up Next

Evolving Pediatric Airway Surgery: A Look at Education and Outreach in India with Dr. Deepak Mehta on the BackTable ENT Podcast)
Challenges and Innovations in Pediatric Dysphagia Management with Dr. Nikhila Raol on the BackTable ENT Podcast)
In-Office Ear Tubes in Children with Dr. Jordan Schramm on the BackTable ENT Podcast)
Surgical Ergonomics: The Unseen Risk to Surgeon Wellbeing with Dr. Geeta Lal on the BackTable ENT Podcast)
American Head and Neck Society Scholarship for Underrepresented Minority Medical Students with Dr. Tammara Watts on the BackTable ENT Podcast)
In-Office Procedures for Chronic Rhinitis with Dr. Stan McClurg on the BackTable ENT Podcast)



Learn about Laryngology on BackTable ENT

Get in touch!

We want to hear from you. Let us know if you’re interested in partnering with BackTable as a Podcast guest, a sponsor, or as a member of the BackTable Team.

Select which show(s) you would like to subscribe to:

Thanks! Message sent.

bottom of page