SM13: Geriatric Patient Boom Expected to Put Strain on Otolaryngologists

In Dr. Bennett’s specific case, the woman was given hearing aids, but over time her hearing worsened, with slight cognitive decline and discrimination scores in the mid-30s. Dr. Sataloff said he’d be looking for a cause like an autoimmune disorder. “A lot of people don’t look until it’s very late, but it’s there early,” he said.

The patient eventually had a cochlear implant workup and was implanted in the worse-performing ear. Dr. Bennett said this might have been a case of a feedback loop involving dementia and hearing loss, with hearing loss leading to social isolation, which led to dementia, more isolation and more hearing loss, and so on.

Case 2: Facial Paralysis

Dr. Parnes discussed a 78-year-old man with facial paralysis on the right side that had come about gradually over five months. An MRI two months earlier had reportedly shown nothing abnormal. The patient’s overall health seemed good: He was alert and oriented, with a normal gait, ear exam and neurological exam.

“In the world I live in, this is a parotid tumor until proven otherwise,” Dr. Eibling said. Dr. Parnes said an MRI was re-done and was negative. Gold weight placement was done to protect the movement of the right eye, he said. An MRI performed 11 months after the man first sought medical help showed an increased signal in the right mastoid air cells, but no sign of a tumor. The man declined intervention at that point, including facial re-animation.

“In every discussion I had with this gentleman, I said, ‘You know, I think you have a tumor and we’ve just been unable to find it,’” said Dr. Parnes.

Four months later, the man reported hearing loss on his right side. Dr. Sataloff said his first step would be a repeat MRI, because he would worry about that change. Dr. Parnes said that option was decided against, because the patient had already undergone three MRIs, with normal results. Facial re-animation was performed at that point and, aesthetically, the results were good. But the man’s overall health declined, with more hearing loss, rapid decline in mental status and weakness. Eventually, the patient was taken to the ER.

His worst suspicion was confirmed, Dr. Parnes said: “Despite the fact of having three normal MRIs prior to this, he had a massive tumor at the base of the skull…. It’s surprising to me that a tumor of this size could not have been seen on previous MRIs. But I think in retrospect, if we’d gotten an MRI when we started to get the unilateral hearing loss, we probably would have picked something up.” The family, with physician guidance, opted for palliative care rather than medical intervention, and the man died about six months later.