Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

THIEME Original Research Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old Caroline Fernandes Rimoli1 Evaldo Dacheux Macedo Filho2 Cynthia Fontoura Klas4 Giovana Aryane Nascimento4 1 Department of Otolaryngology, Hospital IPO, Curitiba, PR, Brazil 2 NEP, Hospital Paranaense de Otorrinolaringologia IPO, Curitiba, PR, Brazil 3 Department of Otorrinolaringology, Universidade Federal do Maria Theresa Costa Ramos Oliveira Patrial3 Address for correspondence Caroline Fernandes Rimoli, Department of Otolaryngology, Hospital IPO, Av. República Argentina, 2069, Água Verde, Curitiba, Paraná 80620010, Brazil (e-mail: ). Paraná, Curitiba, PR, Brazil 4 Evangelic Faculty of Parana Curitiba, Curitiba, Paraná, Brazil Int Arch Otorhinolaryngol 2020;24(1):e53–e61. Abstract Keywords ► Microsurgery ► larynx ► elderly ► squamous cell carcinoma ► reinke edema Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associated with laryngeal lesions and determine prevention and treatment approaches. Introduction Considering the increase in life expectancy, it is estimated that, in 2050, the elderly population will be of 2 billions,
22% of the global population.1 It is estimated that, in 2020, Brazil will be the 6th country with the largest elderly population, of
32 million people, similar values to those currently observed in developed received May 13, 2019 accepted September 7, 2019 DOI https://doi.org/ 10.1055/s-0039-1698780. ISSN 1809-9777. countries.2 This panorama has encouraged the development of researches focused on this population group aiming at actions that may ensure healthy and active aging. Roy et al3 have performed an interesting epidemiological study, through electronic databases, about laryngeal disorders (surgical or not) that affected elderly patients in the United States between 2004 and 2008. They found > 60 thousand Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil e53 e54 Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old patients, with an average age of 75 years old. The most common disorders were hoarseness and acute laryngitis, with 44 and 21%, respectively. There are no specific data on surgical disorders. Advanced age was associated with the increase in hoarseness diagnoses and with the reduction of benign lesions. It was also observed an increase of laryngeal paresis/paralysis and reduction of Laryngeal cancer. Concerning gender, it was observed that women have less chance of presenting laryngeal cancer, paresis, and paralysis. However this group presents most of the hoarseness, acute laryngitis, and laryngospasm. Zhukhovitskaya et al4 studied the epidemiology of benign laryngeal lesions of 602 patients treated at a hospital in New York in a 5-year period. A total of 641 lesions were identified. There was a significant prevalence of nodules and pseudocysts in younger patients, while for the age group of > 60 years old, the most prevalent lesions, with statistical significance, were Reinke edema and leukoplakia. According to these authors, association between these disorders and advanced age can be explained by the cumulative effect of exposure to irritants. Surgery in elderly patients requires knowledge on the alterations on the larynx due to aging. Over the years, there are alterations on the elastic and collagen fibers on the lamina propria. The thinning and mucosal atrophy and atrophy of secretory glands also occur. The disorders that usually affect this age group are: vocal fold atrophy, vocal sulcus, glottic incompetence, and vocal fold edema. Other common conditions include polyps, nodules, and Reinke edema.5 There are no specific global data about laryngeal surgery in elderly patients. Therefore, the present study aims at analyzing the profile of laryngeal microsurgery on this population. Methods This is a retrospective observational study, with a crosssectional design. The present project was approved by the Human Research Ethics Committee under the number CAAE: 73073417.8.00 00.5529. A retrospective analysis of medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in the south of Brazil, between January 2004 and December 2016. In Brazil, according to the “Statute of the Elderly” (Law 10.741/03), every person > 60 years old is considered elderly, so that was the age considered for the present study. Patients with incomplete medical records were excluded from the study. Clinical diagnosis was based on laryngoscopic examination (with stroboscopy when necessary), and confirmed by anatomopathological examination. The results observed for age were described by mean, standard deviation (SD), median and amplitude. Percentage and frequency values were presented for categorical variables. For the comparison among age groups regarding diagnoses, the chi-squared test was used. To perform the analysis considering gender and the fact of being professional voice users, the International Archives of Otorhinolaryngology Vol. 24 No. 1/2020 Rimoli et al. Fisher exact test was used. A multivariate analysis of factors related to squamous cell carcinoma (SCC) diagnosis was performed by adjusting a logistic regression model and using the Wald test. Values of p < 0.05 indicated statistical significance. Data were analyzed using the software IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). Results After excluding 4 patients with incomplete medical records, the analysis presented 213 laryngeal microsurgeries pe (...truncated)