Misdiagnosis of Aging

Abstract

Program Description: This miniseminar will illustrate the potential “misdiagnoses” of aging and highlight management of common geriatric symptoms. The presentation format will emphasize key points through illustrative cases. Audience participation will be encouraged through the use of interactive keypads. The population demographics of North America are changing rapidly, with an increasing number of elderly individuals. In otolaryngology, age-related changes in hearing, vestibular function, smell, and phonation are recognized, as are changes in the soft tissues of the head and neck. Some of these changes are compounded by co-morbidities in other organ systems. It is tempting to dismiss a geriatric patient’s complaints as part of “normal aging.” In doing so there is a risk of missing the same correctable pathology we see in younger patients. The presentation in elderly patients may be subtle and/or atypical, resulting in failure to order appropriate diagnostic tests. Symptoms commonly misdiagnosed as “normal” aging include dizziness, dysphonia, and rhinorrhea. Such assumptions may “blind” the otolaryngologist to treatable etiologies, such as benign positional vertigo, polypharmacy, or allergic rhinitis. The consequences of these potential misdiagnoses directly impact both the level of functioning and quality of life of the geriatric patient. Complaints should be attributed to aging only through exclusion or positive evidence. When this is the case, it is important to recognize that many of the symptoms may nonetheless be managed successfully. Presbyphonia may improve significantly with voice therapy and possibly vocal fold augmentation. Hearing loss frequently is amenable to rehabilitation with an appropriate hearing aid. Multiple symptoms are the rule rather than the exception, and treatment results in a more highly functioning patient with an improved quality of life. In some cases intervention may mean the difference between an autonomous individual and one who is dependent or living in a home.

Educational Objectives: 1) Describe the problem of misdiagnosis. 2) Identify frequent misdiagnoses and recognize the subtle and atypical presentations of disorders in elderly patients. 3) Identify treatable complaints attributable to “normal” aging.