Geriatric Otolaryngology

by Calhoun; Karen H.

• ISBN13: 9780824728502
• ISBN10: 0824728505
• Format: Hardcover
• Copyright: 2006-01-13
• Publisher: CRC Press

Summary

Opening with a clear overview of the biology and demographics of aging, this text authoritatively summarizes the most recent knowledge on disorders of the ears, nose, paranasal sinuses, oral cavity, larynx, voice, throat, and neck in the geriatric population. With chapters by prominent leaders in the discipline, this reference serves as an invaluable source of guidance on perioperative assessment, operative procedures and outcomes, and new strategies for reconstructive and cosmetic surgery.

Table of Contents

Preface	vii
Contributors	xxix
PART I: GERIATRIC OTOLARYNGOLOGY
Clinical Approach to the Geriatric Patient	1	(16)
Michelina Fato
Demographics of Aging in America	2	(2)
Practical Approach to the Office Visit	4	(1)
Obtaining the History	5	(1)
Social History	6	(1)
Nutrition	6	(1)
Alcohol, Tobacco, and Drug Use Disorders	7	(1)
Functional Status	7	(1)
End of Life	7	(1)
Physical Examination	8	(1)
Elder Abuse and Neglect	8	(1)
Depression and Suicide	9	(1)
Summary	9	(1)
Appendix	10	(4)
References	14	(3)
Biology of Aging	17	(8)
Mukaila A. Raji
James S. Goodwin
Introduction	17	(1)
Life Expectancy, Life Quality, and Life Span	17	(1)
Theories of Aging	18	(4)
Antiaging Interventions---Insight and Potentials from Aging Theories	22	(1)
Summary and Conclusion	23	(1)
References	23	(2)
Introduction to Geriatric Otolaryngology	25	(18)
Hinrich Staecker
Introduction	25	(1)
The Auditory System	25	(6)
Vestibular System	31	(1)
The Nose and Sinuses	32	(1)
Tongue/Oral Cavity and Swallowing	33	(2)
Larynx	35	(2)
Conclusions	37	(1)
References	37	(6)
Cerumen Impaction	43	(16)
Cyrus Torchinsky
Terence M. Davidson
Introduction	43	(1)
Anatomy and Physiology of Cerumen	43	(4)
Pathophysiology	47	(1)
Incidence	48	(1)
Treatment	49	(1)
Complications of Cerumen Removal	50	(1)
Our Practice Algorithm	51	(1)
Historical Precedent and Conclusions	52	(4)
References	56	(3)
Amplification and the Geriatric Patient	59	(18)
Catherine V. Palmer
Amanda Ortmann
General Description of the Clinical Problem	59	(1)
Why Is Hearing Loss Particularly Important in the Geriatric Population?	59	(1)
Basic Science	60	(1)
History	60	(2)
Physical Examination	62	(1)
Testing	62	(1)
Treatment Options	63	(10)
References	73	(1)
Annotated Bibliography	74	(3)
Presbycusis	77	(14)
Sidney N. Busis
Incidence	77	(1)
Recognition	78	(1)
Peripheral Pathology	79	(1)
Audiometric Patterns	80	(1)
Central Auditory Pathways	80	(2)
Molecular Mechanisms	82	(1)
Genetic Factors	83	(1)
Evaluation	83	(2)
Management	85	(3)
References	88	(3)
Tinnitus in the Elderly Patient	91	(10)
Steven M. Parnes
Tinnitus	91	(1)
Tinnitus That Originates from Para-auditory Structures (Objective Tinnitus)	92	(2)
Sensorineural (Subjective) Tinnitus	94	(4)
Conclusions	98	(1)
References	98	(3)
Hearing Protection for the Retired Adult	101	(8)
Marshall Chasin
Joanne DeLuzio
Introduction	101	(1)
Hearing Protection	102	(2)
Acoustically (and Electronically) Tuned Hearing Protection	104	(2)
Rating Hearing Protection	106	(1)
Strategies for Grandchildren to Protect Their Hearing	107	(1)
References	108	(1)
Multisensory Impairment in Older Adults: Evaluation and Intervention	109	(16)
Susan L. Whitney
Laura O. Morris
Introduction	109	(1)
Normal Age-Related Changes	110	(1)
Pathological Sensory Changes in the Older Adult	111	(1)
Somatosensory Screening	111	(2)
Visual Screening	113	(2)
Vestibular Screening for Older People	115	(3)
Intervention for Multisensory Disequilibrium	118	(3)
References	121	(1)
Annotated Bibliography	122	(3)
Mal de Debarquement	125	(10)
Timothy C. Hain
Dario A. Yacovino
General Description of the Clinical Problem	125	(1)
Basic Science	125	(2)
Potential Etiologic Factors in MDD	127	(3)
Diagnosis of MDD	130	(1)
Treatment of MDD	131	(1)
Algorithm	132	(1)
Summary	133	(1)
References	133	(2)
Meniere's Disease in the Elderly	135	(12)
Ronen Perez
Julian M. Nedzelski
Epidemiology	135	(1)
Pathogenesis	136	(1)
Diagnosis	137	(3)
Treatment	140	(2)
Summary	142	(1)
References	143	(2)
Annotated Bibliography	145	(2)
Dizziness in the Elderly	147	(8)
David E. Eibling
Introduction	147	(2)
Taxonomy of Dizziness in the Elderly	149	(1)
Role of the Otolaryngologist in Non-vestibular Dizziness	150	(1)
Approach to the Patient with Non-vestibular Dizziness	151	(1)
Treatment of Non-vestibular Dizziness	152	(1)
Summary	153	(1)
References	153	(2)
Benign Paroxysmal Positional Vertigo	155	(10)
Joseph M. Furman
General Description of the Clinical Problem	155	(1)
Pathophysiology of BPPV	156	(1)
Clinical Presentation	157	(2)
Treatment of BPPV	159	(3)
References	162	(2)
Annotated Bibliography	164	(1)
Balance Rehabilitation	165	(8)
Horst R. Konrad
Meiho Nakayama
Introduction	166	(1)
General Description of the Clinical Problem	167	(3)
Summary	170	(1)
References	171	(2)
PART II: TASTE, SMELL, AND NASAL PROBLEMS
Olfaction and Aging	173	(8)
Karen J. Fong
Mark A. Zacharek
Introduction	173	(1)
Definitions	174	(1)
Etiologies of Olfactory Loss	174	(1)
Pathophysiology of Olfactory Loss with Aging	174	(2)
Patient, Evaluation	176	(1)
Treatment and Counseling	177	(2)
References	179	(2)
Olfactory Dysfunction in Neurodegenerative Diseases	181	(14)
Richard L. Doty
Introduction	181	(1)
Neurodegenerative Diseases with Marked Olfactory Dysfunction	182	(5)
Neurodegenerative Diseases with Less Marked or Minimal Olfactory Dysfunction	187	(3)
Conclusions	190	(1)
References	191	(4)
Taste Changes in the Elderly	195	(10)
Natasha Mirza
Introduction	195	(1)
Development of the Taste System	195	(1)
Anatomy of the Taste System	196	(1)
Taste Transduction	197	(1)
Innervation of the Tongue	198	(1)
Review of Literature	199	(1)
Reasons for Loss of Taste in the Elderly	200	(1)
Effects of Taste Loss in the Elderly	201	(1)
Therapy for Taste Loss	202	(1)
Conclusion	202	(1)
References	202	(3)
Sinusitis: Diagnosis, Treatment, and Complications	205	(8)
Berrylin J. Ferguson
Umamaheswar Duvvuri
Introduction	205	(1)
Acute Sinusitis	205	(2)
Antibiotic Selection	207	(2)
Chronic Sinusitis	209	(1)
Chronic Fungal Rhinosinusitis	210	(1)
Chronic Invasive Fungal Sinusitis	211	(1)
Summary	212	(1)
References	212	(1)
Allergic Rhinitis in the Elderly	213	(12)
Stephen J. Chadwick
Background	213	(2)
Patient Presentation and History	215	(2)
Diagnosis	217	(1)
Management	217	(2)
Immunotherapy	219	(1)
Food Allergy	220	(1)
Summary	220	(1)
References	221	(4)
Rhinitis in the Aging Patient	225	(14)
Margaret A. Chen
Terence M. Davidson
Introduction	225	(1)
Overview of Normal Nasal Physiology	225	(1)
Pathophysiology of Aging Rhinitis	226	(1)
Clinical Assessment	227	(1)
Management	228	(7)
Conclusion	235	(1)
References	236	(3)
Epistaxis in the Geriatric Population	239	(10)
Dana S. Smith
Mark K. Wax
Introduction	239	(1)
Anatomy	239	(1)
Etiology	240	(1)
Evaluation of Epistaxis	241	(1)
Treatment of Epistaxis	242	(3)
Summary	245	(1)
References	246	(3)
PART III: ORAL DISORDERS
Oral Mucosal Pathology in the Geriatric Population	249	(12)
Bobby M. Collins
Herpes Simplex	250	(1)
Erythema Multiforme	251	(1)
Pemphigoid	252	(1)
Pemphigus	252	(2)
Lichen Planus	254	(2)
Lichenoid Drug Reaction	256	(1)
Aphthous Ulcers	256	(1)
Biopsy	257	(1)
Selected Suggested Medications	258	(1)
Bibliography	259	(2)
Halitosis in the Elderly	261	(4)
David E. Eibling
Introduction	261	(1)
Approach to the Patient with Halitosis	262	(1)
Treatment of Halitosis	262	(2)
Conclusion	264	(1)
References	264	(1)
Oral Health Care of the Elderly Patient	265	(8)
Azfar A. Siddiqui
Introduction	265	(1)
Dental Loss in the Elderly	265	(1)
Changes in Oral Dental Health with Aging	265	(1)
Dentures in the Elderly	266	(1)
Treatment of Denture Problems in the Elderly	266	(1)
Dental Caries	267	(1)
Treatment	268	(1)
Periodontal Disease	268	(1)
Treatment of Periodontal Disease	268	(1)
Oral Health of Cancer Patients	269	(1)
Denture Care	270	(1)
Summary	271	(1)
Reference	271	(2)
Burning Mouth	273	(4)
David E. Eibling
Introduction	273	(1)
Representative Case	273	(1)
Epidemiology of BMS	274	(1)
Etiology	274	(1)
Evaluation and Management of Patients with BMS	275	(1)
Summary	276	(1)
References	276	(1)
PART IV: VOICE AND SWALLOWING
Effects of Aging on Swallowing	277	(16)
JoAnne Robbins
Nadine Connor
Steven Barczi
Introduction	277	(1)
The Impact of Dysphagia	278	(1)
Normal Swallowing	278	(2)
Neurophysiology of Oropharyngeal Swallow	280	(1)
Senescent Swallowing	281	(4)
Differential Considerations for Dysphagia and Aspiration	285	(2)
Dysphagia Intervention--Prevention Paradigms	287	(1)
Summary	288	(1)
References	288	(5)
Dysphagia Evaluation	293	(10)
Jonathan E. Aviv
Thomas Murry
Introduction	293	(1)
Epidemiology	293	(1)
Etiology	294	(1)
Diagnostic Techniques	295	(1)
Treatment	296	(3)
Summary	299	(1)
References	299	(4)
Xerostomia in the Elderly	303	(10)
Karen M. Kost
Introduction	303	(1)
Physiology	303	(1)
Etiology	304	(3)
Clinical Consequences of Xerostomia	307	(1)
The Work Up of Xerostomia	307	(1)
Management of Xerostomia	308	(1)
Oral Care---Topical Agents	309	(1)
Oral Care---Systemic Agents	309	(1)
Other Treatments	310	(1)
Summary	310	(1)
References	311	(2)
Zenker's Diverticulum	313	(12)
Daniel H. Coelho
Douglas A. Ross
Clarence T. Sasaki
General Description of the Clinical Problem	313	(1)
Why Is Zenker's Diverticulum Particularly Important in the Geriatric Population?	313	(1)
Basic Science	313	(2)
History	315	(1)
Physical Examination	315	(1)
Testing	316	(1)
Differential Diagnosis	316	(1)
Treatment Options	317	(3)
Algorithm	320	(1)
Conclusion	321	(1)
References	321	(2)
Bibliography	323	(2)
Surgical Management of Aspiration in the Geriatric Patient	325	(6)
David E. Eibling
Introduction	325	(1)
Ethical Dilemmas	325	(1)
Approach to the Patient	326	(1)
Treatment of Intractable Aspiration	326	(1)
Vocal Cord Medialization	327	(1)
Cricopharyngeal Myotomy or Chemodenervation	327	(1)
Aerodigestive Separation	327	(1)
Laryngeal Stenting	327	(1)
Total Laryngectomy	328	(1)
Laryngeal Closure	328	(1)
Laryngotracheal Separation	328	(1)
Summary	329	(1)
References	329	(2)
Sialorrhea in the Geriatric Population	331	(6)
Sam J. Daniel
General Description of the Clinical Problem	331	(1)
Why Is Sialorrhea Particularly Important in the Geriatric Population?	331	(1)
Basic Science	331	(1)
History	332	(1)
Physical Examination	332	(1)
Differential Diagnosis	332	(1)
Testing	333	(1)
Treatment Options	333	(2)
Summary	335	(1)
Bibliography	335	(2)
Post-Stroke Swallowing Rehabilitation	337	(12)
Stephanie K. Daniels
Anne L. Foundas
Introduction	337	(1)
Lesion Localization and Swallowing	337	(2)
Screening for Dysphagia in Acute Stroke	339	(2)
Instrumental Evaluation of Oropharyngeal Dysphagia	341	(1)
Treatment of Oropharyngeal Dysphagia	342	(2)
Summary	344	(1)
References	345	(4)
The Effects of Age on the Voice	349	(16)
Robert Thayer Sataloff
Sue Ellen Linville
Introduction	349	(1)
Anatomy and Physiology	349	(3)
Correlates of Anatomic Changes from Young Adulthood to Old Age	352	(1)
Variability in Measures of Voice and Speech	353	(1)
The Adult Voice	353	(1)
The Aging Voice	353	(1)
Aging	354	(1)
Medical Intervention	354	(1)
Psychology and Intellect	355	(1)
Endocrine System	355	(1)
Neurologic Diseases	356	(1)
Head and Neck	356	(1)
Other Conditions	356	(1)
Voice Therapy	356	(1)
Surgery	357	(3)
Conclusion	360	(1)
References	360	(5)
Vocal Fold Paralysis: Surgical Treatment	365	(10)
Steven M. Zeitels
General Description of the Clinical Problem	365	(1)
Why Is UVP Particularly Important in the Geriatric Population, Including Recent Concepts in Pathophysiology?	365	(1)
History	366	(1)
Physical Examination	367	(1)
Differential Diagnosis	367	(1)
Testing	367	(1)
Treatment Options	368	(1)
Injection Medialization	368	(1)
Laryngoplastic Phonosurgery: Background	369	(1)
Principles and Theory of Laryngeal Framework Surgery	369	(1)
Medialization Laryngoplasty	369	(1)
Arytenoid Procedures: Posterior Glottal Incompetence	370	(1)
Cricothyroid Subluxation	371	(1)
References	372	(1)
Recommended Reading	373	(2)
Cough	375	(8)
David E. Eibling
Introduction	375	(1)
Cough as a Physiologic Function	375	(1)
Cough as a Symptom	376	(1)
Chronic Cough as a Complaint	376	(2)
Chronic Cough in the Elderly	378	(1)
Approach to the Patient with Cough	378	(1)
History of the Patient with Cough	378	(1)
Physical Examination of the Patient with Cough	379	(1)
Additional Testing	380	(1)
Treatment of Chronic Cough	381	(1)
Summary	381	(1)
References	382	(1)
Laryngopharyngeal Reflux in the Elderly	383	(12)
Karen M. Kost
Richard J. Payne
Introduction	383	(1)
Laryngopharyngeal Reflux	384	(2)
Clinical Evaluation	386	(3)
Management of LPR	389	(2)
Summary	391	(1)
References	392	(3)
PART V: SLEEP DISORDERS
Identifying and Treating Sleep Disorders in the Elderly	395	(16)
Lianqi Liu
Sonia Ancoli-Israel
Lavinia Fiorentino
General Description of the Clinical Problem	395	(1)
Normal Sleep	395	(1)
Why Is Poor Sleep Particularly Important in the Geriatric Population?	396	(1)
History	396	(1)
Differential Diagnosis	397	(5)
Testing	402	(1)
Treatment	403	(4)
Conclusion	407	(1)
References	408	(3)
Methodologies in the Diagnosis of Sleep Apnea	411	(18)
Gopal Allada
Definitions of Sleep-Disordered Breathing (SDB)	411	(1)
Epidemiology of SDB in the Elderly	412	(1)
Reasons for Sleep Apnea in the Elderly	412	(1)
Taking the History of a Patient with Suspected OSAHS	413	(1)
Clinical Examination of a Patient with Suspected OSAHS	414	(2)
Radiologic Imaging in the Diagnosis of Obstructive Sleep Apnea	416	(1)
Specific Methodologies in the Diagnosis of OSAHS	417	(1)
Unattended Monitoring in Diagnosing OSAHS	418	(3)
Polysomnography in the Evaluation of OSAHS	421	(1)
Recent Reviews and Guidelines	422	(3)
Clinical Decision-Making Algorithm	425	(1)
Summary	425	(1)
References	425	(4)
Snoring: Simple to Obstructive Apnea	429	(8)
Kenny P. Pang
Amy R. Blanchard
David J. Terris
Introduction	429	(1)
Epidemiology	430	(1)
Pathophysiology	430	(1)
Differential Diagnosis	431	(1)
Clinical Examination	432	(1)
Lateral Cephalometry	433	(1)
Diagnosis of SDB	434	(1)
Snoring Treatment	434	(1)
Summary	435	(1)
References	436	(1)
Upper Airway Resistance Syndrome	437	(12)
Michel A. Cramer Bornemann
Vance D. Bachelder
Robert H. Maisel
Introduction	437	(1)
Definitions in Sleep-Disordered Breathing	438	(1)
Determinants of Upper Airway Patency During Sleep	438	(1)
Sleep in the Elderly	439	(1)
The First Descriptions of UARS	440	(2)
Pathophysiology of UARS	442	(1)
Clinical Features and Diagnosis of UARS	443	(2)
Sequelae of UARS	445	(1)
Noninvasive Clinical Management	446	(1)
Difficulties in Assessing Surgical Outcomes in UARS	446	(1)
References	447	(2)
Surgical Treatment of Sleep-Disordered Breathing	449	(10)
Kenny P. Pang
Amy R. Blanchard
David J. Terris
Introduction	449	(1)
Nasal CPAP	450	(1)
Oral Appliances	450	(1)
Surgical Treatment	451	(5)
Conclusions	456	(1)
References	456	(3)
Obstructive Sleep Apnea Epidemiology and Patient-Centered Measures	459	(12)
Eric J. Kezirian
Edward M. Weaver
Introduction	459	(1)
Definitions of Obstructive Sleep Apnea Syndrome	459	(1)
Prevalence of Obstructive Sleep Apnea Syndrome in Geriatrics	460	(1)
Is Sleep Apnea Different in the Elderly?	461	(1)
Sleep Apnea and Quality of Life	462	(1)
Assessment of Symptoms in Sleep Apnea	463	(1)
Assessment of Sleep Apnea---Related Quality of Life	463	(1)
Geriatric Sleep Apnea and Quality of Life	463	(3)
Conclusions	466	(1)
References	466	(5)
PART VI: HEAD AND NECK PROBLEMS
Overview of Head and Neck Cancer	471	(12)
Miriam N. Lango
Ara A. Chalian
Introduction	471	(1)
Aging and Cancer	472	(1)
Biology of Aging and Cancer	473	(2)
Treatment of the Elderly Head and Neck Cancer Patient	475	(1)
Age, Comorbidity, and Functional Status	475	(1)
Comorbidity	476	(1)
Functional Status	477	(1)
Cognition/Nutrition/Social Support/Polypharmacy	478	(1)
Therapeutic Options for Elderly Head and Neck Cancer Patients	478	(1)
Perioperative Risk Assessment	479	(1)
Incidence of Surgical and Nonsurgical Complications in the Elderly	479	(1)
Therapeutic Modalities: Functional Outcomes and Quality of Life	480	(1)
References	480	(1)
Annotated Bibliography	481	(2)
Head and Neck Cancer in the Geriatric Patient	483	(8)
Jack L. Gluckman
Michael Wolfe
Introduction	483	(1)
Evaluation of the Geriatric Patient with Head and Neck Cancer	484	(2)
The Decision-Making Process	486	(1)
Therapeutic Modalities	486	(2)
Patient Follow-Up	488	(1)
Rehabilitation	489	(1)
Conclusion	489	(1)
References	489	(1)
Annotated Bibliography	490	(1)
Thyroid Diseases in the Elderly	491	(10)
Maisie Shindo
Frances Tanzella
Introduction	491	(1)
Hypothyroidism	491	(2)
Hyperthyroidism	493	(3)
Nontoxic Goiters	496	(2)
Thyroid Malignancies	498	(1)
References	499	(2)
Parathyroid Diseases in the Elderly	501	(12)
Maisie Shindo
Frances Tanzella
Pathophysiology of Hyperparathyroidism	501	(1)
Diagnosis	502	(1)
Manifestations of Primary Hyperparathyroidism	502	(2)
Evaluation	504	(1)
Surgical Treatment	504	(4)
Nonsurgical Management	508	(1)
Outcome of Treatment	508	(1)
Conclusions	509	(1)
References	509	(4)
Facial Nerve Dysfunction: Etiology and Incidence in the Elderly---Acute Management	513	(8)
Catherine P. Winslow
Mark K. Wax
Introduction	513	(1)
Anatomy	513	(1)
Etiology	514	(1)
Classification	514	(1)
Investigation	514	(1)
Management	515	(4)
References	519	(2)
Disorders of the Salivary Glands	521	(8)
Karen T. Pitman
Jonas T. Johnson
Introduction	521	(1)
Basic Science	521	(1)
History	522	(1)
Physical Examination	523	(1)
Diagnostic Testing	524	(1)
Common Salivary Disorders	524	(2)
Treatment Options	526	(1)
Summary	527	(1)
References	527	(2)
Reconstructive Issues in the Elderly Patient with Head and Neck Cancer	529	(12)
Eric Genden
Mark K. Wax
Introduction	529	(1)
Types of Flaps	530	(2)
Fasciocutaneous Free Tissue	532	(4)
Summary	536	(2)
References	538	(3)
PART VII: APPEARANCE CHANGES
Appearance Changes with Aging	541	(14)
Donna J. Millay
Introduction	541	(1)
Skin Changes	541	(4)
Skin Lesions	545	(1)
Appearance Changes of the Head and Neck	546	(1)
Forehead	547	(2)
Periorbital Region	549	(1)
Midface Region	550	(1)
Nose	550	(1)
Perioral Region	551	(1)
Neck	551	(1)
Ear	552	(1)
Summary	553	(1)
References	553	(2)
Reconstruction in the Elderly Patient	555	(26)
Adam T. Ross
Tom D. Wang
Introduction	555	(1)
Reconstruction and Depression	556	(1)
Anesthesia	556	(1)
Effects of Aging	557	(1)
Etiology	557	(1)
Preoperative Assessment	558	(1)
General Reconstructive Concepts	558	(4)
Types of Reconstruction	562	(8)
Anatomical Considerations in the Elderly	570	(5)
Trauma and the Elderly Patient	575	(2)
Summary	577	(1)
References	578	(3)
Cosmetic Surgery in the Elderly Patient	581	(22)
Oren Friedman
Tom D. Wang
Ted A. Cook
Introduction	581	(1)
The Aging Process	582	(1)
Rejuvenation of the Aging Face	582	(1)
The Aging Face Syndrome	583	(16)
Conclusion	599	(1)
References	599	(4)
PART VIII: PSYCHOSOCIAL ISSUES IN THE CARE OF THE ELDERLY
Delirium and Dementia in the Elderly	603	(6)
Serge Gauthier
Delirium	603	(1)
Dementia	604	(4)
References	608	(1)
Sensory Impairment and Deprivation in the Elderly	609	(8)
Allen R. Huang
Visual Impairment	610	(1)
Auditory Impairment	611	(1)
Smell and Taste Disturbances	611	(1)
Tactile Impairment	612	(1)
Assessment	612	(1)
Management and Interventions	613	(2)
Conclusions	615	(1)
References	615	(2)
Social Isolation	617	(8)
Vanessa Sakadakis
Introduction	617	(1)
Social Isolation and Loneliness	617	(1)
Social Isolation and Elderly People	618	(1)
Assessment and Intervention	619	(2)
Conclusion	621	(1)
References	621	(1)
Annotated Bibliography	622	(3)
Substance Misuse in the Elderly	625	(10)
David W. Oslin
Introduction	625	(1)
General Description of the Clinical Problem	625	(1)
Magnitude of the Problem	626	(1)
Why Is Substance Abuse Particularly Important in the Geriatric Population?	627	(1)
Common Presentations in the Geriatric Population	628	(1)
Physical Exam and Lab Testing	629	(1)
Treatment Options	630	(3)
Summary	633	(1)
References	633	(2)
Elder Abuse	635	(12)
Mark J. Yaffe
Introduction	635	(1)
Definition	635	(1)
Manifestations	636	(1)
Epidemiology	637	(1)
Risk Factors	638	(1)
Mortality Consequences of Elder Abuse	638	(1)
Physician Detection	639	(1)
Elder Abuse Screening	640	(1)
Outcomes from Detection	640	(1)
Summary	641	(1)
References	641	(6)
Anxiety and Depression in Older Patients	647	(14)
Jeffrey P. Staab
Introduction	647	(1)
Overview of Anxiety and Depression in the Elderly	647	(1)
Manifestations of Anxiety and Depression in Otorhinolaryngologic Practice	648	(2)
Association of Anxiety and Depression with Otorhinolaryngologic Illnesses	650	(3)
Head and Neck Surgery	653	(1)
Diagnosis and Treatment of Anxiety and Depression in Otorhinolaryngologic Practice	654	(3)
Treatment Options	657	(1)
Conclusion	658	(1)
References	659	(1)
Annotated Bibliography	660	(1)
Coordination of Care	661	(6)
Steven C. Zweig
Care Coordination	661	(3)
The Future of Care Coordination	664	(1)
References	664	(3)
Polypharmacy in Older Adults	667	(8)
Emily R. Hajjar
Joseph T. Hanlon
Introduction	667	(1)
Polypharmacy Definitions and Epidemiology	667	(1)
Consequences of Polypharmacy	668	(2)
Principles of Geriatric Pharmacotherapy	670	(1)
Summary	671	(1)
References	671	(4)
PART IX: PERIOPERATIVE ISSUES
Preoperative Evaluation	675	(10)
Christopher D. Newell
Introduction	675	(1)
Cardiovascular System	675	(2)
Pulmonary System	677	(1)
Endocrine System	677	(1)
Renal System	677	(1)
Nervous System	678	(1)
Nutrition	678	(1)
Preoperative Testing	678	(3)
Risk Stratification	681	(1)
Conclusion	682	(1)
References	682	(3)
Anesthesia for Otorhinolaryngologic Surgery in the Elderly	685	(20)
Myrdalis Diaz-Ramirez
Introduction	685	(1)
Physiologic Changes in the Elderly and Common Comorbidities	686	(5)
Preoperative Evaluation and Treatment	691	(2)
Intraoperative Care	693	(6)
Postoperative Complications	699	(1)
Specific Cases	699	(2)
Conclusion	701	(1)
References	701	(4)
Postoperative Care for the Geriatric Patient	705	(10)
Robert L. Cross Jr.
Richard Hanson
Introduction	705	(1)
Cardiovascular System	705	(1)
Pulmonary System	706	(2)
Gastrointestinal System	708	(1)
Renal System	709	(1)
Endocrine System	709	(1)
Neurologic System	710	(2)
Conclusion	712	(1)
Bibliography	712	(3)
Informed Consent	715	(6)
Cheryl Ellis Vaiani
References	721	(1)
Pain Management in the Elderly	721	(18)
David Sibell
The Size of the Problem	721	(1)
Basic Science of Chronic Pain	722	(2)
Diagnosis of Painful Disorders in the Elderly	724	(2)
Differential Diagnosis	726	(2)
Treatment Options	728	(5)
Interventional Treatments	733	(2)
General Treatment Concepts	735	(1)
References	735	(4)
PART X: END OF LIFE
Advance Directives and Do Not Resuscitate Orders	739	(6)
Cheryl Ellis Vaiani
References	742	(3)
End-of-Life Issues in the Otolaryngology---Head and Neck Surgery Patient	745	(20)
Gerry F. Funk
Introduction	745	(1)
HNC Management from a Palliative Care Perspective	745	(1)
Special Considerations in the Terminal Care of HNC Patients	746	(1)
History and Information Gathering	747	(1)
Physical Examination	748	(1)
Developing a Plan	749	(1)
Specific Management Issues	750	(10)
Summary	760	(1)
Case Studies	760	(2)
References	762	(2)
Annotated Bibliography	764	(1)
Hospice for the Otolaryngologist	765	(6)
Paul Bascom
Historical Perspective	765	(1)
Hospice---A Philosophy of Care and a Program of Services	766	(1)
Discussing Hospice Care with Patients and Families	767	(4)
Index	771