Beruflich Dokumente
Kultur Dokumente
Geriatric Otolaryngology
Literature Reading
Yanuar Iman Santosa
DEPARTMENT OF OTORHINOLARYNGOLOGY - HEAD&NECK SURGERY
PADJADJARAN UNIVERSITY / HASAN SADIKIN GENERAL HOSPITAL
BANDUNG
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
07-Nov-13
Biology of Aging
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
07-Nov-13
Theory of aging
Somatic mutation theory accumulation of mutations
decreases function aging
Error theory random errors in replication of DNA
Program theory a purposeful sequence of events is
written into the genome growth, development, aging, and
death
Mutation
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Error
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Epidemiology of otolaryngologic
disorders among the elderly
Diagnosis
Surgery
Otitis media
Dysequilibrium
ENT malignancy
Epistaxis
Rhinoplasty
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
07-Nov-13
Presbycusis
Presbycusis
Hearing-aid technology
Increasing number and the decreasing cost hearing devices improve
quality of life
Presbycusis is no longer considered a major factor that causes older
patients to withdraw from the world around them.
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
07-Nov-13
Tinnitus
Tinnitus
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
07-Nov-13
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Vocal quality
Known causes :
ossification of the laryngeal cartilages
limitation of arytenoid cartilage excursion
incomplete glottic closure
decreased number of collagen and elastin
fibers
atrophy of the laryngeal muscles
Edema of the vocal folds (smokers)
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Other factors :
Degenerative diseases
drugs
radiation therapy
viral infections
endocrine disorders
Neoplasms
trauma
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Older patients > nasal drainage, postnasal drip, rhinitis, and olfactory
ability
Upper respiratory infections underdiagnosed inappropriately treated
These infections account for a large proportion of the use of the
healthcare system.
Predisposing factors :
previous nasal fractures
- allergic rhinitis
viral upper respiratory infection
- Dehydration
foreign bodies
- dental abscesses
nasal polyposis
- use of nasal sprays
Aspirin
- nasal intubation
immune system
Kern et al. apoptotic of olfactory sensory neurons hyposmia and
anosmia
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Presbyphagia
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Peripheral Nerves
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Geriatric Immunology
Age immune system
Lymphocytes effectivity because :
function of helper and cytotoxic T-cell
The general response to antigens and immunogens
The thymus gland involutes
Older T and B cells produce a weaker response
The quality of the overall response (less IgG and fewer
antibodies)
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Special considerations :
Anxiety about medical costs,
Lack of knowledge or concern about symptoms,
Social isolation,
Lack of personal physician, and
Fatalistic attitudes about disease and treatment outcome.
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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These changes
slow wound healing and reduce inflammatory response
Common benign skin lesions :
seborrheic keratosis
skin tags
cherry hemangioma
chondrodermatitis nodularis chronica helices
angular cheilitis
Xanthelasma
Keratoacanthoma
Wrinkles
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Airway Management
A major issue :
the need for prolonged intubation (longer than 2 weeks)
Injury caused by :
material biotoxicity
cuff pressure
tube wall pressure.
Complications :
tracheal stenosis : 5% to 10% after 10 days of intubation
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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07-Nov-13
Laryngotracheal pathology :
diffuse edema
mucosal erosion over the arytenoid vocal process
granulation tissue
vocal cord paralysis
Nasal ulceration or sinusitis may result from prolonged
intubation
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Facial Fractures
Bone healing capacity
Due to :
endocrinopathy
disturbed calcium metabolism
suboptimal nutritional status
and a reduced blood supply
blood supply depends on vessels in the subperiosteal
minimum periosteal elevation during management
age, bone resorption loss > 50% mandibular height.
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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Osteoporosis
Facial bone
ADULT
ELDERLY
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Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Highlights
Aging is the sum of many phenomena: disease, environmental
insult, injuries, nutrition, and genetic programming.
The etiology is not fully understood.
Theories of aging : limited cell replications, somatic mutation
theory, the error theory, and the program theory.
Ataxia of the elderly (presbyastasis) damaging falls
significant morbidity, mortality, and high health-care costs.
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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07-Nov-13
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
Bailey, Byron J., Head & Neck Surgery - Otolaryngology, 4th Edition, Lippincott Williams & Wilkins, 2006, Ch 17. Geriatric Otolaryngology
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THANK YOU
Thank you
Antioxidant
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Spasmodic Disphonia
Botox treatment
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Cilia dysfunction
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Types of Presbiacusis
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