Surgery for chronic otitis media in the elderly.

PURPOSE: To evaluate the effectiveness and safety of surgery for chronic otitis media in elderly patients, compared to younger adults and children. METHODS: Patients with chronic otitis media with and without cholesteatoma formation were assessed. Patients aged 65 years and older were included and compared to adults aged 35-55 and to children. Effectiveness was evaluated by comparing postoperative dry and safe ears in ages groups, safety was assessed by comparing postoperative adverse events. RESULTS: Postoperative success and adverse events did not differ between age groups. Children had more recurrent cholesteatoma than adults. No difference in recurrent cholesteatoma between adults was observed. CONCLUSION: Surgical treatment for chronic otitis media with and without cholesteatoma in elderly patients is safe and effective. Age has no influence on postoperative adverse events and treatment outcomes in chronic otitis media. Cholesteatoma recurrence was not different between adult age groups.

Hearing Disabilities and the Effectiveness of Rehabilitation in Different Age Groups.

OBJECTIVE: To assess differences in hearing disabilities between different age groups and the effectiveness of rehabilitation with hearing aids. STUDY DESIGN: Retrospective chart review. SETTING: First line hearing aid dispensers. PATIENTS: First-time hearing aid users divided in a younger group aged 18 to 65 years (119 subjects) and an elderly group aged 70 years and older (213 subjects). INTERVENTION(S): Rehabilitative. MAIN OUTCOME MEASURE(S): Weighted pure tone averages (PTA) were calculated using the binaural impairment model. The patient-reported outcome measures (PROMs) Amsterdam Questionnaire for Auditory Disabilities (AVAB), and client oriented scale of improvement (COSI) were collected pre- and post-fitting. To analyze whether age group, weighted PTA, and type of auditory dimension influences AVAB, linear regression and two-way ANalysis Of VAriance models were used. RESULTS: The weighted PTA of the young group was significantly lower than of the elderly group. In the regression model differences between age groups were found to be significant for pre-AVAB and for AVAB benefit. The two-way ANalysis Of VAriance showed that the effect of age on pre- and post-AVAB scores was not influenced by PTA or the type of auditory dimension. CONCLUSIONS: Younger first-time hearing aid users experience more auditory disabilities, despite better hearing levels than their elderly counterparts. Their disabilities are rehabilitated more effectively by hearing aids.

Success Rate of Tympanic Membrane Closure in the Elderly Compared to Younger Adults.

OBJECTIVE: To assess the effectiveness and safety of tympanoplasty in elderly patients and the effect of frailty on the results. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Thirty-one ears in 30 patients aged 65 years and older were included and matched with 31 controls, based on the type of surgery, of a pool of 133 patients aged 35 to 55 years. INTERVENTION: Therapeutic. MAIN OUTCOME MEASURE: Success was defined as tympanic membrane closure and resolution of presenting complaints. Complications were assessed. Frailty was defined by assessing multimorbidity and polypharmacy. Fisher's exact test was used to compare success and complication rates between the age groups. Linear logistic regression analysis using generalized linear models was performed on success and complication rate. RESULTS: Success rates in both the groups were 84%. Complication rate in the elderly group was 16% versus 6% in the control group. This difference was not statistically significant in the Fisher's exact test. In the generalized linear model analysis age group, multimorbidity and polypharmacy had no significant influence on both success and complication rate. CONCLUSION: There was no difference in success and complication rate in elderly undergoing tympanoplasty compared with younger adults. Having multimorbidity or polypharmacy did not correlate with failure of the tympanic membrane closure or a higher complication rate.

Analysis of Oxford medial unicompartmental knee replacement using the minimally invasive technique in patients aged 60 and above: an independent prospective series.

We present the outcome of an independent prospective series of phase-3 Oxford medial mobile-bearing unicompartmental knee replacement surgery. Eight surgeons performed the 154 procedures in a community-based hospital between 1998 and 2003 for patients aged 60 and above. Seventeen knees were revised; in 14 cases a total knee replacement was performed, in 3 cases a component of the unicompartmental knee prosthesis was revised, resulting in a survival rate of 89% during these 2-7 years follow-up interval. This study shows that mobile-bearing unicompartmental knee replacement using a minimally invasive technique is a demanding procedure. The study emphasises the importance of routine in surgical management and strict adherence to indications and operation technique used to reduce outcome failure.