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Why do geriatric patients visit otorhinolaryngology?

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June 14, 2016
by Gul Soylu Ozler, MD; Erhan Yengil, MD

Abstract

The number and proportion of people more than 65 years old in the population are increasing with the rise in life expectancy. This study was designed to investigate the otolarygologic needs and visits of geriatric patients. We conducted a retrospective study that included all patients ≥65 years of age who visited the otolaryngology department between 8 a.m. and 4 p.m. during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart and analyzed. In 2012, a total of 19,875 patients attended the otolaryngology department between 8 a.m. and 4 p.m., of whom 418 (2.1%) were aged ≥65 years. The most common complaints were ear and hearing disorders (24.2%), epistaxis(15.3%), balance disorders (15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%). This study shows that the changing patient population will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.

Introduction

The number of people more than 65 years old and the proportion of elderly people in the population are increasing with the rise in life expectancy.1 This change in demographic distribution necessitates better healthcare for this population. We know geriatric patients have more serious medical problems so they use medical services more frequently than younger people.2 Worldwide life expectancy today is 65.4 years, whereas it was 48 years in 1955.3 By 2020 it is foreseen that it will reach 68.1 years and at the same time the geriatric population in the world will be more than 1 billion.3 In Turkey, by 2020, the geriatric population will comprise almost 7.7% of the population, compared to just 5.6% in 2000 and 4.2% in 1985.4 Life expectancy in 2020 will be 73.9 years, whereas it was 70 years in 2002.4

This study was designed to investigate otolarygologic needs and visits of geriatric patients.


Patients and methods

We conducted a retrospective study that included all patients ≥65 years old who visited the otolaryngology department between 8 a.m. and 4 p.m. in the Viranşehir State Hospital during 1 year. Age, gender, main complaint, and clinical diagnosis were noted on a chart. Ethics committee approval was obtained, and the study was conducted in adherence to the Declaration of Helsinki. Informed consent was obtained from all participants.


Statistical analysis

Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences) 15.0 Evaluation for Windows. The chi-square test was used for categorical variables when comparing the groups. The statistically significant level was accepted as a p value <0.05.


Results

In 2012, a total of 19,875 patients visited the otolaryngology department between 8 a.m. and 4 p.m. of whom 418 (2.1%) were aged ≥65 years. Every day 2.97 ± 1.29 (minimum 1, maximum 7) geriatric patients were examined and treated in the otolaryngology department. There was an almost equal gender representation (49.5% women). Their mean age was 77.8 ± 7.81 years (range 63 to 98); 163 patients (39%) were ≥75 years old, and 88 patients (21.1%) were ≥85.

The table lists the patients' chief complaints and their clinical diagnoses. The most common complaints were ear and hearing disorders (24.2%), epistaxis (15.3%), balance disorders(15.1%), pharyngotonsillar pathologies (14.8%), and head and facial trauma (9.6%).

Table. Patients' presenting complaints and clinical diagnoses (N = 418)

Chief complaint/diagnosis

No. of cases (%)

Ear and hearing disorders

101 (24.2)

Epistaxis

64 (15.3)

Balance disorders

63 (15.1)

 Benign paroxysmal positional vertigo

35 (8.4)

 Cervical spondylosis

6 (1.4)

 Vestibular neuronitis

4 (0.95)

 Ménière disease

3 (0.71)

 Central vertigo

15 (3.6)

Pharyngotonsillar pathology

62 (14.8)

Head and facial trauma

40 (9.6)

 Nasal bone fracture

20 (4.8)

 Maxillofacial trauma

15 (3.6)

 Tympanic membrane perforation

5 (1.2)

Age-related hearing loss

31 (7.4)

Inflammatory or infectious ear diseases

25 (6.0)

Cerumen impaction

21 (5.0)

Sinonasal pathology

20 (4.8)

 Acute sinusitis

8 (1.9)

 Chronic sinusitis

6 (1.4)

 Chronic sinusitis + nasal polyposis

4 (0.95)

 Antrochoanal polyps

2 (0.47)

Tinnitus

19 (4.5)

Salivary gland diseases

18 (4.3)

 Sialodenitis

8 (1.9)

 Sialolithiasis

8 (1.9)

 Benign tumors

2 (0.47)

Voice and respiratory disorders

16 (3.8)

 Acute laryngitis

8 (1.9)

 Chronic laryngitis

4 (0.95)

 Vocal fold palsy

2 (0.47)

 Tracheostomy

2 (0.47)

Swallowing pathologies

15 (3.6)

Allergic reactions

10 (2.4)

Facial paralysis

9 (2.2)

Foreign body in ear

3 (0.71)

Sudden hearing loss

2 (0.47)

Otologic symptoms were the leading complaint: 30.6% of these 101 cases were due to hearing loss, 24.7% were due to inflammatory or infectious ear diseases, and the others were related to cerumen impaction (20.8%) or tinnitus (18.8%). Of the epistaxis cases, 95.3% were anterior epistaxis; 39% had hypertension; 15.6% used anticoagulant agents; 40.6% had both hypertension and used anticoagulant agents; and 4.68% had hematologic diseases.

Benign paroxysmal positional vertigo was diagnosed in 55.5% of the 63 vestibulopathy cases. Of these, 23.8% were referred to neurology. Chronic pharyngitis was the leading of pharyngotonsillar pathology.

The most frequent trauma mechanisms were: falls (62.5%), motor vehicle accidents (17.5%), direct trauma (12.5%), and being run over (7.5%). Half of the trauma cases had nasal bone fractures. None had facial nerve dysfunction due to trauma. Living alone can be accepted as a risk factor for trauma in geriatric patients, because 65% of the patients were living alone.

Sinonasal pathologies were due to acute sinusitis in 40% of the 20 cases, while the others were due to chronic sinusitis (30%), chronic sinusitis with nasal polyposis (20%), and antrachoanal polyps (10%). The most common salivary gland disorders were acute sialoadenitis and sialolithiasis seen with equal frequency.

Acute laryngitis was the leading voice and respiratory disorder. All cases of facial paralysis were due to Bell palsy. The figure shows clinical diagnoses for patients according to age: 65 to 74 years, 75 to 84 years, and ≥85 years of age.


Figure. Graph shows the clinical diagnoses according to the patients' ages.


Discussion

The rise in life expectancy affects many fields of medicine, including otolaryngology. Elderly patients visiting an otolaryngologist need special attention because of issues that are unique to their population. This increased proportion of geriatric patients has implications for the type and frequency of diseases that general otolaryngologists see in their practices.

Although the proportion of geriatric patients has increased, there has been little literature assessing how these changes in demographics have affected and will affect otolaryngology. In a study conducted by Dagan et al, balance disorders were the leading symptom seen in elderly patients, followed by head and facial trauma, epistaxis, and otologic complaints.5 Creighton et al found that the most common complaints in the elderly were otologic complaints (hearing loss, external ear disorders, tinnitus, nonsuppurative otitis media/eustachian tube disorders) and balance disorders.6

Creighton's data show that as patients age, otologic complaints increase, while rhinologic and head and neck diagnoses seen in general otolaryngology practices decrease.6 This decrease in head and neck complaints is contrary to previously published data investigating the aging population, specifically on head and neck disease.7

Okoye and Onotai reported that otologic diseases were the most common, followed by rhinologic disease and laryngologic pathologies.8 Chronic suppurative otitis media was the the most common otologic problem, followed by otomycosis externa and cerumen impaction. Allergic rhinitis was the most common rhinological pathology, while chronic pharyngitis topped the list of diseases of the throat.

Timsit et al found that the most frequent nasal sign in elderly patients was epistaxis, the most frequent auditory condition was acute external/middle ear inflammation, and the most common pharyngeal condition was foreign body ingestion.9 Lin and Bhattacharyya found that the most common otologic diagnosis was sensorineural hearing loss.10

As in other reports in the literature, the most common complaints in our study were ear and hearing disorders, epistaxis, balance disorders, pharyngotonsillar pathologies and head and facial trauma.

Age-related hearing loss, known as presbycusis, is characterized by progressive bilaterally symmetric sensorineural hearing loss due to atrophy of epithelial cells in the basal turn of the cochlea. Age-related hearing loss is the most prevalent chronic condition in people older than 65 years of age.11

Epistaxis was the second most common complaint in our study. The widespread use of anticoagulant medications (acetylsalicylic acid, warfarin, low-molecular-weight heparin, and clopidogrel) creates difficulties when treating bleeding in elderly patients. Adding to this problem are essential hypertension and vasculopathies, which are often found in this population.12

Balance disorders are also common in the elderly. The vestibular apparatus has degenerative changes as part of the aging process. Pathologic studies have demonstrated that neuronal degeneration in maculae and cristae with neuroepithelium damage in the utricle, saccule, and ampulla of the semicircular canals are responsible for this condition.

In our study, benign paroxysmal positional vertigo was diagnosed in 55.5% of the 63 vestibulopathy cases. In contrast, the study conducted by Lin and Bhattacharyya found that the most common vestibulopathy was Ménière disease, followed by vestibular neuritis and benign positional paroxysmal vertigo.10 Chronic pharyngitis was at the top of the pharyngotonsillar pathologies in our study.

In our study, 9.6% of geriatric patients had a complaint of head and facial trauma. The most frequent trauma mechanisms were: falls (62.5%), motor vehicle accidents (17.5%), direct trauma (12.5%), and being run over (7.5%). In a study conducted by Rodrigues and Ciosak, the trauma mechanisms were falls (75.9%), being run over (9.6%), direct trauma (5.4%), and motor vehicle accidents (3.8%).13

Female sex, the utilization of continuous-use medication, and the presence of hearing impairment and vision problems significantly increased the risk of trauma due to falls. If the factors that greatly influence trauma among the elderly are evaluated, it is possible to promote health interventions that favor their prevention.13


Conclusion

This study shows that the changing population trends are currently affecting the patient population seen by otolaryngologists. This will change the type and frequencies of pathologies seen in general otolaryngology practices. Geriatric patients need a targeted approach to their diseases because they have special issues unique to their population.

 


References

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  12. Hansen ML, Sørensen R, Clausen MT ,et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med 2010; 170 (16): 1433-41.
  13. Rodrigues J, Ciosak SI. Elderly victims of trauma: Analysis of the risk factors [in Portuguese]. Rev Esc Enferm USP 2012; 46 (6): 1400-5.
From the Department of Otorhinolaryngology (Dr. Ozler) and the Department of Family Medicine (Dr. Yengil), Mustafa Kemal University, Hatay, Turkey. The study described in this article was conducted at Viranşehir State Hospital, Şanlıurfa, Turkey.
Corresponding author: Dr. Gül Soylu Özler, Faculty of Medicine, Department of Otorhinolaryngology, Mustafa Kemal University, Hatay, Turkey. Email: soylugul@yahoo.com
Ear Nose Throat J. 2016 June;95(6):224-229