|Year : 2021 | Volume
| Issue : 5 | Page : 640-646
The distribution of geriatric problems in otolaryngology and their alteration from young adults
O Onay1, C Aydin2
1 Department of ENT, Atilim University, Faculty of Medicine, Ankara, Turkey
2 Medicana International Hospital, ENT Clinic, Ankara, Turkey
|Date of Submission||21-Sep-2019|
|Date of Acceptance||10-Aug-2020|
|Date of Web Publication||20-May-2021|
Dr. O Onay
Department of ENT, Faculty of Medicine, Atilim University, Kizilcasar Mahallesi, Incek, Golbasi/Ankara
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Many changes occur in human physiology with aging, and as expected complaints of geriatric patients differ from the other age groups in population. Aims: The objective of the study was to investigate the common complaints of geriatric patients attending to an otolaryngology clinic (ENT clinic), and to compare their complaints with the 18–65 years aged patients'. Materials and Methods: A total number of 41888 adult patients who visited the ENT clinic from 2015 to 2018 were retrospectively investigated. Patient complaints were scanned, and subcategorized as five groups (otologic/rhinologic/head and neck/ others/ neoplasias) and all data were evaluated. Results: Forty-one thousand, eight hundred and eighty-eight patients were included in the study, and 3946 of them were geriatric patients. The most frequent problem was otologic problems, followed by rhinologic problems among geriatric patients. However, rhinologic problems were the major complaint among the 18–65-year-old patients. A comparison of all the individual complaints bringing the geriatric patients to the ENT clinic revealed the three most frequent complaints: 1. hearing loss, 2. balance disorders, and 3. common cold. However, the three major complaints beyond nongeriatric adults were 1. tonsillopharyngeal disease, 2. common cold, and 3. inflammatory and infectious diseases of the sinuses, and these differences were statistically significant (P = 0.001*). Conclusion: It was found in this study that the five most frequently reported complaints of geriatric patients when applying to an ENT clinic are hearing loss, loss of balance, common cold, cerumen, and tonsillopharyngeal diseases. Unlike from nongeriatric population, otologic problems (most commonly hearing loss) were the essential ENT clinic complaints of geriatric patients.
Keywords: Age factors, elderly, geriatric otolaryngology, patient demographics
|How to cite this article:|
Onay O, Aydin C. The distribution of geriatric problems in otolaryngology and their alteration from young adults. Niger J Clin Pract 2021;24:640-6
| Introduction|| |
The elderly population around the world is growing as life expectancy increases. It is projected that this shift in population distribution by age will accordingly lead to a change in the future practices and areas of interest within the discipline of medicine. According to the World Health Organization, the line of demarcation for middle-aged and elderly is 65 years. Data from the World Health Organization, and the United Nations on U.S. and global trends in aging indicate that, in the United States, the proportion of the population aged 65 and older is expected to increase from 12.4% in 2000 to 19.6% in 2030, which translates into approximately 71 million persons. The number of those 80 years and older is expected to increase from 9.3 million to 19.5 million in 2030.
In the field of otolaryngology, studies done with geriatric patients are quite new. Considering the changes that occur in human physiology with aging, it seems quite possible to see different complaints. There is limited information about geriatric subgroup of otolaryngology, and most of the data on these patients in the literature is based on personal experience and predictions depending on the data gathered from total population. This is a comprehensive study including 3946 geriatric patients and it investigates the change in the frequency of visits by patients over 65 to otolaryngology clinics, enlarges upon the complaints of these patients, and analyses whether the complaints of the patients aged over 65 differ from those of the patients aged between 18 and 65.
| Material and Methods|| |
Files of the patients who applied to the ENT clinic of the Medicana International Ankara Hospital between 2015 and 2018 were retrospectively scanned. This study was approved by the Medicana International Ankara Hospital Institutional Review Board, and for this type of study, informed formal consents were not required. Follow-up examinations which performed 10 days after the initial examination, examinations without ICD (International Statistical Classification of Diseases and Related Health Problems) number, and examinations that include complaints relevant to other specialization areas than otolaryngology were excluded. The total number of patients included in the study was 41888 of which 3943 were over 65 years age (geriatric patients). Complaints of these patients were recorded. It was aimed to determine what the complaints of the geriatric patient group were while applying to the ENT clinic and what was the frequency of occurrence of these complaints, and to enlight that if the complaints of the geriatric patients differ from those of the patients aged between 18 and 65.
Classification of the Complaints
The diagnoses based on the patient complaints were classified into four groups as otologic problems, rhinologic problems, head and neck problems, and other problems.
Complaints related to otology were categorized into nine subgroups as follows: 1. Inflammatory and infectious ear diseases, 2. Cerumen, 3. Peripheral facial paralysis, 4. Balance disorders, 5. Hearing loss, 6. Tinnitus, 7. Eustachian tube More Details dysfunction, 8. Ear injuries, and 9. Foreign bodies in the ear.
Complaints related to rhinology were categorized into eight subgroups as follows: 1. Common cold, 2. Inflammatory and infectious diseases of the sinuses, 3. Types of rhinitis, 4. Anatomic causes of obstruction, 5. Epistaxis, 6. Anosmia, 7. Nasal trauma, and 7. Foreign bodies in the nose.
Complaints related to head and neck problems were categorized into eight subgroups as follows: 1. Inflammatory diseases of the oral mucosa, 2. Inflammatory and infectious tonsillopharyngeal diseases, 3. Neck swelling, 4. Voice and breathing disorders, 5. Salivary gland diseases, 6. Temporomandibular joint disorders, 7. Neck injuries, and 8. Foreign bodies in the pharynx and larynx.
In addition to these three main categories, another two groups were created as the 4th and 5th category which were followed as other problems (e.g., cough, dysphagia, dyspnea, sleep disorder) and neoplasias (head and neck malign or benign neoplasias).
In this study which was aimed to compare the complaints of patients aged over 65 and aged between 18-65 years, we defined statistical power at least 0.80 for each variable and type 1 error was determined as 0.05. The results of definitive statistics for continuous variables were reported as numbers (n) and percentage (%). The comparison of complaints according to the age groups were performed by Z-test, P value <0.05 was considered statistically significant, and analyses were performed by SPSS (IBM SPSS for Windows, ver. 24).
| Results|| |
The total number of patients who visited the ENT clinic of our hospital during four years was (n) 41888 (20642 males, 21246 females) and 9.4% (n: 3946) of these patients were in the geriatric age group. Of the patients aged over 65, 2043 were males while 1903 were females [Table 1] and [Figure 1]. The mean age of the geriatric group was 71.8 ± 5.82 years (range: 66 to 98). The age distribution of the patients who visited the clinic through the years 2015 and 2018 as those aged over 65 and those aged between 18 and 65 years is shown in [Figure 1]. On average, 916 geriatric patients per year visited ENT clinic and three geriatric patients per a day were examined by the otorhinolaryngologist.
|Figure 1: Patients classified by their ages and their distribution according to years. Geriatric patients' application to ENT clinic remains 8.5%–10% of total examination in ENT clinic|
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Of the three major categories of complaints (otologic problems, rhinologic problems, and head and neck problems), when we inspected geriatric patients, it was found that most frequent one was the otologic problems (n: 1989) followed by rhinologic problems (n: 930) and head and neck problems (n: 698). On the other hand, rhinologic problems were more common (n: 16561) among the young adults (18–65 years) followed by otologic problems (n: 10103) and head and neck problems (n: 10096). These data are detailed in [Figure 2].
|Figure 2: Comparison of the number of diagnosis in each subspecialty category between ≥65 year aged patients and at 18–65 years. Otologic problems are major complaints of geriatric patients; however, nongeriatric patients essential complaints are rhinologic complaints|
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A comparison of all the individual complaints bringing the geriatric patients to the ENT clinic revealed the five most frequent complaints: 1. hearing loss (n: 875), 2. balance disorders (n: 431), 3. common cold (n: 347), 4. cerumen (n: 283), and 5. inflammatory tonsillopharyngeal diseases (n: 222). Otologic problems constituted 50% of the complaints in geriatric patients and were more common among geriatric group. The most frequent complaint reported was hearing loss with a rate of 22% among geriatric group. Within the groups of nose problems and head and neck problems, the main causes of visit were the inflammatory and infectious complaints; among the rhinologic problems, the most frequent cause of visit was common cold (n: 347), while inflammatory/infectious tonsillopharyngeal diseases (n: 274) were the most common complaints related to head and neck problems. Inflammatory diseases were more commonly seen by the 18–65 years aged groups, and it was statistically significant (P = 0.001*). Distribution of all complaints is presented in [Table 2], [Table 3], [Table 4], [Table 5], [Table 6] in details and the the number of patinets' diagnosis in each subspecialty category between geriatric patients and 18–65 years aged patients is shown in [Figure 2].
|Table 6: Number of patients with other (nonclassified) problems for age groups|
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When the geriatric patients' otologic complaints were investigated, the most frequently reported complaint was revealed to be the hearing loss (n: 875) and 624 of them were diagnosed with presbycusis. However, in the 18–65 years aged patient group, the most common problem was inflammatory/infectious ear diseases (n: 3691). The rarest ear problem for both groups was ear injuries. Hearing loss, vertiginous problems, tinnitus, and Bell's palsy were more common in the geriatric age group; these all were statistically significant (P = 0.001*). Cerumen, inflammatory/infectious ear diseases, ear injuries, and foreign bodies in the ear were more common in the 18–65 years aged group and were statistically significant (P = 0.001*) [Table 2]. Distribution of the otologic complaints is presented in [Figure 3].
|Figure 3: Otologic problems of patients. Most frequent otologic problem for geriatric patients was hearing loss; however, in nongeriatric adults, most frequent otologic problem was inflammatory/infectious ear disease; this difference was statistically significant (P* = 0.001)|
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When the rhinologic complaints were investigated [Table 3], it was seen that the most frequent complaint was common cold for both groups and likewise, the rarest complaint was foreign bodies in the nose for both age groups [Figure 4]. No cases of foreign bodies in nose, pharynx, or larynx were recorded as the cause of visits by geriatric patients. Regarding the head and neck-related problems, the most frequent one was reported as inflammatory/infectious tonsillopharyngeal diseases (n: 274) and the rarest head and neck-related complaint was neck injuries (n: 2). Nasopharyngitis, epistaxis, and anosmia were more common in the geriatric age group; these all were statistically significant (P = 0.001*) [Table 4] and [Figure 5].
|Figure 4: Rhinologic problems of patients. Most frequent first and second rhinologic problem for geriatric and nongeriatric patients were alternately common cold and inflammatory/infectious diseases of the sinuses. These complaints were more common for nongeriatric patients, and there was a statistical significance (P = 0.001*) between these two groups|
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|Figure 5: Head and neck problems of patients. Most frequent first and second head and neck problem for geriatric and nongeriatric patients were alternately inflammatory/infectious tonsillopharyngeal diseases and neck swelling. These complaints were more common for nongeriatric patients, and there was a statistical significance (P = 0.001*) between these two groups|
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Neoplasias classification contained malignancies and benign neoplasias. Among malignancies, there was no statistical difference (P = 0.591) between the age groups. However, benign neoplasias were more common in the 18–65 years aged group, and this was statistically significant (P = 0.001*) [Table 5]. When the types of malignancies in the geriatric patient group were investigated, it was seen that the most frequently reported type was laryngeal and hypopharyngeal carcinomas (n: 115) and the rarest type was nasal and paranasal sinus carcinomas (n: 4). Distribution of the malignancies reported is presented in [Figure 6] in detail. Also, other complaints (e.g., cough, dysphagia, dyspnea, sleep disorders, reflux) is clarified in [Table 6].
|Figure 6: Head and neck malignancy frequencies for geriatric patients. Most frequent malignancy observed was laryngeal/hypopharyngeal carcinomas|
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| Discussion|| |
There is an ongoing increase in the number of the individuals aged over 65 in the world population. It is inevitable that this change in the population structure will have an effect on the field of health services. Although there is abundant data on these changes in the age distribution within the population, the number of studies discovering the effect of this demographic shift on the field of otolaryngology is limited. Considering the fact that 35% of the health services provided in the USA in 2000 were used by geriatric patients, it is clear that determining the needs of this group that frequently receives medical treatment and care is of utmost importance. In the ENT clinic of our hospital, the number of the visits by the geriatric patients corresponded to 8.5%–10% of all patients who visited the clinic in the last 4 years. The increase in the number of the geriatric patients who visited our clinic was not statistically significant. The percentage of the visits made by geriatric patients to our clinic was 10.8% (n: 985) in 2015, 11% (n: 884) in 2016, 9.7% (n: 1044) in 2017, and 7.3% (n: 1020) in 2018. Contrary to expectations, our clinic witnessed a tendency toward decreasing the number of visits by geriatric patients. But the 18–65 years aged patients' clinical visits seem to have a statistically significant increase (P = 0.001*). According to the data provided by Creighton et al., the percentage of the visits by geriatric patients rose from 14.3% in 2004 to 17.9% in 2010 and showed a statistically significant increase. Additionally, they also showed that; predictive analysis shows that at the current rate, almost 30% of all patients seen by 2030 would be over the age of 65 years.
An increasing number of comorbidities brought by aging results in the frequent use of the health system and resources. The literature counts hearing loss, balance disorders, airway problems, and head and neck cancers among the complaints that become more common with age. According to the data provided by WHO, 30%–35% of the patients over the age of 60 suffer from presbycusis, while this rate rises to 40%–45% in patients over the age of 70. Presbycusis has been reported in the literature as the most frequent cause of visit to the clinics in geriatric patients.,,,, In addition, the frequency of occurrence of hearing loss, which is known to deteriorate the patients' communication capability and cause social inadequacy, is 30%-43% in geriatric patients.,,,, Although a little lower in percentage-wise terms when compared to what is reported in the literature, the most common complaint of the geriatric patients who visited our clinic was also hearing impairment, consisting 22% of the overall complaints. Because of the increasing importance on the quality of life in aging, individuals may be more frequently seeking evaluation for hearing complaints. Hearing loss deteriorates the quality of life, especially in the patient groups of low socioeconomic status who have limited access to healthcare. Unless treated, this may lead to depression, isolation, and suicidal tendencies.
Two infective-inflammatory processes stand out in the most common five causes of visits to our clinic. Common cold and tonsillophayrngeal infections were found responsible for the complaints of the elderly with rates of 8.8% and 7%, respectively. Although not being an urgent medical condition and having a good prognosis due to spontaneous regression, upper respiratory infections in geriatric patients may lead to negative clinical pictures when combined with relevant comorbidities. In a study conducted by Ozler et al. with geriatric Turkish population, it was found similarly that tonsillopharyngeal infectious pathologies were the fourth most common cause of visit to clinics and they correspond to 14.8% of all complaints. This may be why these infectious processes made their way into the major complaints of the geriatric patients while applying to the clinic. Another factor may be that patients are still yet to embrace the stepwise healthcare system and they tend to apply to tertiary centers for complaints of any level.
Nasal complaints in patients over 65, on the other hand, constituted 23.6% of all complaints. Only 3.2% of these (n: 125) was caused by epistaxis. Unlike this low percentage reported in our study, the research of Chi and Yuan and Dagan et al. which explored the visits to ER (emergency room) due to otolaryngologic complaints counted epistaxis as one of the major complaints and found that 11%–13% of the geriatric visits to ER was caused by epistaxis., This data implies that geriatric patients with active nose bleeding mostly prefer to visit ER at night, rather than visiting ENT clinics in the daytime.
Advanced age is a risk factor in head and neck cancers. Hence, it is unsurprising that 49% (n: 218) of the patients who applied to our clinic due to malignancies [Figure 6] were patients aged over 65. The most frequently reported type of malignancy in our patients was laryngeal and hypopharyngeal carcinomas (n: 115) although in general population, oral cavity cancer is the most common type of head and neck cancers. It should be kept in mind that in geriatric patients, all the symptoms counted above may refer to a finding of malignancy and physical examination should be performed with maximum attention.
| Conclusion|| |
The causes of visits to ear, nose, and throat clinics have witnessed a remarkable change together with the ever-aging population. However, there has been a relatively small number of studies in the literature assessing how these changes in demographics have affected and will affect otolaryngology. Patients over the age of 65 mostly visit to physicians with their own distinctive complaints that are quite different from those of general population. Thus, elderly patients visiting an otolaryngologist need special attention because of issues that are unique to their population. It was found in this study that the five most frequently reported complaints of geriatric patients when applying to ear, nose, and throat clinics are hearing loss, loss of balance, common cold, cerumen, and tonsillopharyngeal diseases. In addition to this statistical data, it is also necessary to elucidate the physiopathologic changes occurring in the geriatric age group in order to be able to provide a better diagnostic and treatment process to this specific group. In addition, considering the fact that this is yet a mostly undiscovered field on which the number of studies is quite limited, it may also be considered to incorporate geriatric otolaryngology in the training process of the resident physicians and in the accreditation exams.
| Compliance with ethical standards|| |
This study was approved by the Medicana International Ankara Hospital Institutional Review Board.
For this type of study formal consent is not required.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]