The American Society of Geriatric Otolaryngology

Ear, Nose & Throat Journal, Dec, 2007 by Jerome C. Goldstein

The inaugural meeting of the American Society of Geriatric Otolaryngology (ASGO) took place in April 2007 at the Combined Otolaryngological Society Meetings (COSM) in San Diego. As president of ASGO, I was pleased to preside over the meeting and delivered the Presidential Address. This new society was established by a group of otolaryngologists who recognize that our fast-growing older population is subject to a number of disorders of interest to the practitioners of our specialty. These include, but are not limited to, hearing and balance problems, dysphonia, dysphagia, rhinitis, allergy, loss of taste and smell, and head and neck cancer. Cosmetic concerns are also significant, since older people often report feeling younger than their stated age and sometimes want to look it!

According to U.S. Census Bureau data, in 1907 the life expectancy of a male in the United States was 47 years. In the past three decades, the population of the United States has increased by nearly 40%, but the over-65 segment has grown by nearly 90% and the over-85 segment has grown by 232%. Today, approximately 12% of the U.S. population is more than 65 years of age, and by 2030 that percentage will reach 20%. This will amount to approximately 70 million people, which is more than twice the entire population of Canada. Today, approximately one-third of the patients seen by general otolaryngologists are 65 years of age or older, so it is essential for otolaryngologists to have a sound foundation in geriatric otolaryngology. The mission of the ASGO is "to promote the generation and dissemination of knowledge to benefit the geriatric patient with disorders of the ears, nose, throat, head and neck."

Caring for a growing geriatric population requires compassion and planning to meet their needs. Often, the elderly on Medicare have trouble even getting an appointment with some physicians. Once in the office, they often require more time than younger patients. In addition, management of otolaryngologic problems in the elderly is often influenced greatly by systemic conditions outside the head and neck. As geriatric otolaryngologists, we will need to broaden our knowledge about age-related general health problems that can be a factor in ENT disease, such as lipid abnormalities, hypertension, and cardiovascular disease.

Historically, otolaryngologists have been leaders. We are the second oldest medical specialty, and we were the second to establish a certification board in 1924. We were also one of the founders of the American Board of Medical Specialties. Our specialty has a long record of making progress through hard work and providing high-quality care. I personally have lived through the days when we had to "fight" to do thyroid surgery, an operation that is extremely common in our field today. We could not present papers on head and neck cancer at the American College of Surgeons' meetings. Today, we are the third largest specialty in the American College of Surgeons, following general surgery and urology. For the first time in hi story, the incoming president of the American College of Surgeons is an otolaryngologist, Dr. Gerald Healy.

We have a reputation for being innovators--for example, introducing the headlight and then the microscope to surgical practice. We have accomplished all of this and more by upgrading our training programs, by demonstrating competence in our work, and by insisting on excellence in the care we provide. In that same innovative spirit, we recognize the importance of geriatric otolaryngology. Nearly 20 years ago, the American Academy of Otolaryngolog--Head and Neck Surgery (AAO-HNS) hosted a Cherry Blossom Conference on this subject, the proceedings of which are available in a monograph.l

In concluding that Cherry Blossom Conference, Dr. Byron Bailey stated that many preceding speakers had identified different areas of opportunity for the otolaryngologist-head and neck surgeon in the care of the geriatric patient. The areas he discussed then, I believe, are equally applicable today. These include (1) prevention of premature death by the early detection of head and neck cancer and improved management of trauma; (2) prevention of disability, particularly through improved treatment of hearing loss; (3) control and management of symptoms, such as nasal congestion, chronic sinusitis, tinnitus, and vertigo; (4) treatment of common and usually benign diseases, such as upper respiratory infections, otitis, and pharyngitis; (5) management of conditions that limit mobility and promote isolation among the elderly, such as hearing loss, disequilibrium, and voice changes; (6) improvement of the quality of life through facial plastic and reconstructive surgical techniques; and (7) provision of informed participation in societal deliberations concerning social and economic aspects of the disproportionate growth of the elder segment of our population. AAO-HNS has an excellent geriatric textbook available online that summarizes the current state of our knowledge in many of these areas. (2)