Geriatrik Larengoloji
Özet
Dünya genelinde yaşam süresinin uzaması, geriatrik larengoloji ve yaşlanan lareks yapısı üzerine yapılan çalışmaların önemini artırmıştır. Yaşlanma süreciyle birlikte vokal fold epitelinde incelme, elastin ve hiyalüronik asit miktarında azalma ve lamina propriada kollajen birikimi meydana gelmektedir. Bu morfolojik değişimler ses kalitesini etkileyerek seste kısıklık, çabuk yorulma ve "bowing" (yetersiz kapanma) gibi presbilarenks belirtilerine yol açar. Kadınlarda menopoz sonrası hormonal değişimler seste akustik farklılıklar yaratırken, erkeklerde de perde değişimleri gözlenir. Presbilarenks tedavisinde ses terapisi, enjeksiyon laringoplasti ve tiroplasti cerrahisi gibi yöntemler kullanılırken; büyüme faktörleri (bFGF, HGF) ve kök hücre tedavileri umut vaat etmektedir. Yaşlanma aynı zamanda yutma fonksiyonlarını da etkileyerek presbifaji ve disfajiye yol açmaktadır. Kas kitlesi ve kuvvetindeki azalma, tükürük salgısının eksilmesi yutmanın oral ve farengolarengeal fazlarını uzatır; bu da aspirasyon pnömonisi, malnütrisyon ve dehidratasyon riskini artırır. Disfaji rehabilitasyonunda postür modifikasyonları, diyet düzenlemeleri ve NMES, rTMS, tDCS ile PES gibi elektriksel ve manyetik stimülasyon cihazları geleneksel terapilere yardımcı olarak kullanılmaktadır.
The global increase in life expectancy has heightened the significance of research into geriatric laryngology and the aging larynx. The aging process triggers morphological and histological alterations, including thinning of the vocal fold epithelium, reduction of elastin and hyaluronic acid, and collagen accumulation in the lamina propria. These changes negatively affect voice quality, causing presbylaryngis symptoms such as hoarseness, vocal fatigue, and bowing (incomplete glottal closure). Postmenopausal hormonal shifts in women and pitch changes in men lead to converging acoustic characteristics. Treatment options for presbylaryngis include voice therapy, injection laryngoplasty, and thyroplasty, while basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), and mesenchymal stem cell therapies offer promising regenerative solutions. Aging also impacts swallowing functions, leading to presbyphagia and dysphagia. Severe loss of muscle mass, reduced tongue pressure, and xerostomia prolong both oral and pharyngolaryngeal swallowing phases, elevating the risks of aspiration pneumonia, malnutrition, and dehydration. Dysphagia management involves postural adjustments, dietary modifications, and specific muscle exercises, often supplemented by advanced neuromodulatory interventions like NMES, rTMS, tDCS, and pharyngeal electrical stimulation (PES).
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https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
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