1.6 Geriatric Otolaryngology



10.1055/b-0038-162736

1.6 Geriatric Otolaryngology



Key Features





  • The elderly population is expanding rapidly worldwide.



  • The elderly often present with multiple comorbidities.



  • Disease presentation in the elderly may be atypical.



  • For safe performance of surgery in the elderly, thorough preoperative management is important.



Epidemiology


The proportion of the U.S. population aged 65 and older is predicted to expand from 12.4% in 2000 to 19.6% (or 71 million persons) in 2030. Moreover, the over-80 age group is expected to expand from 9.3 million persons to 19.5 million by 2030. Many diseases affecting the elderly involve otorhinolaryngologic care. Comorbidities such as cardiovascular disease, renal disease, and polypharmacy may increase the complexity of safe and effective medical and surgical care for these patients.



Clinical


The clinical approach to the geriatric otolaryngology patient should follow the same general organization as is used for other patients. However, certain areas of the evaluation require specific attention ( Table 1.5 ), as discussed in the Evaluation section.





















Table 1.5 General approach to the elderly patient

History of present illness:


Patient may be a poor historian; obtain primary care records if possible.


Medications:


Obtain accurate current medication list; consider polypharmacy issues.


Social:


DNR status; end-of-life care wishes, advance directives; tobacco and alcohol use; functional status; elder neglect and abuse.


Preoperative:


Careful consideration of risk factors. Testing including CBC, PT, PTT, BMP, chest X-ray, 12-lead ECG. Consider cardiac echo or stress test if risk factors.


Anesthesia:


Consider local, local with IV sedation, versus general.


Examination:


Ancillary testing to consider: audiology, VNG study, videostroboscopy, modified barium swallow.

Abbreviations: DNR, do not resuscitate; CBC, complete blood count; PT, prothrombin time; PTT, partial thromboplastin time; BMP, basic metabolic panel; ECG, electrocardiogram; IV, intravenous; VNG, videonystagmographic.



Diseases


Several aspects of otolaryngology—head and neck surgery are directly impacted by aging. Age-related changes may affect hearing, balance, voice, swallowing, nutrition, olfaction, sleep quality, and cosmetic concerns. Many head and neck neoplasms also have an increased incidence with advanced age. A consideration of some common conditions, by area, follows.



Otology



  • Ceruminosis



  • Serous otitis



  • Presbycusis



  • Tinnitus



  • Balance dysfunction




    • Benign paroxysmal positional vertigo (BPPV)



    • Ménière′s disease



    • Medication side effects



    • Nonvestibular dizziness (related to loss of sensation, proprioception, neuromuscular coordination)



Rhinology



  • Presbyosmia



  • Rhinitis



  • Epistaxis



  • Sinusitis



  • Nasal obstruction from structural collapse (e.g., ptosis, valve collapse)

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May 19, 2020 | Posted by in OTOLARYNGOLOGY | Comments Off on 1.6 Geriatric Otolaryngology

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