From the Guidelines
The best approach for an 80-year-old female with worsening back pain, neurological symptoms, hearing loss, and throat discomfort is immediate comprehensive medical evaluation, prioritizing the assessment of potential serious conditions such as spinal cord compression or systemic diseases that could be indicated by her constellation of symptoms. Given the complexity and potential severity of her condition, she should be taken to the emergency department for a thorough assessment. The emergency physician will likely order imaging studies, such as an MRI of the spine and possibly a CT of the head/neck, along with blood tests including inflammatory markers (ESR, CRP), and a neurological consultation 1.
The treatment plan will depend on the findings but may include pain management with acetaminophen (500-1000mg every 6 hours) or carefully monitored opioids if the pain is severe, along with addressing any identified underlying causes. It's crucial to consider age-related factors, including osteoporosis, increased risk of malignancy, and polypharmacy, in her evaluation and treatment plan. Family members should accompany her to provide history and support during this potentially complex medical workup.
Key considerations in her management include:
- The potential for spinal cord compression, which necessitates urgent evaluation and possible intervention to prevent permanent neurological damage.
- The hearing loss, which could be related to her current condition or a separate issue, possibly requiring an ENT referral for further evaluation, as suggested by the patient herself and considering guidelines for sudden hearing loss 1.
- The sensation of something stuck in her throat, which could indicate a variety of conditions, including but not limited to, esophageal issues or neurological causes, and may require further investigation.
Given the complexity of her presentation, a multidisciplinary approach, including neurology, orthopedics, ENT, and possibly oncology, may be necessary to fully address her symptoms and underlying conditions. The goal of the treatment should be not only to manage her symptoms but also to improve her quality of life, considering her age and potential comorbidities.
From the Research
Patient Presentation
The patient is an 80-year-old female presenting with worsening back pain, neurological symptoms, hearing loss, and a sensation of something stuck in her throat. Her symptoms started one year ago and have worsened over the last two to three months.
Symptoms
- Constant throbbing pain in the neck, mid back, and lower back
- Radiation of pain
- Numbness
- Hearing loss, worse in the right ear
- Sensation of something stuck in the throat
Medical History
- The patient has been seeing Dr. Sobuonie for a pinched nerve in the neck
- She has had neurology involved in her case
- She recently had an ENT appointment with Dr. Kaharrat, who mentioned phlem and recommended an ENT referral
Treatment Options
- For chronic pain, neurosurgical therapy may be an option, but patient selection is crucial for successful surgical therapy 2
- Spinal cord stimulation (SCS) has been shown to be effective in treating chronic pain associated with peripheral neuropathy 3
- SCS is also more effective than reoperation for treating persistent radicular pain after lumbosacral spine surgery 4
- For facial pain, a team approach involving neurology, otolaryngology, dentistry, and psychiatry may be necessary 5
Referral Options
- ENT referral for hearing loss and sensation of something stuck in the throat
- Neurosurgery referral for worsening back pain and neurological symptoms
Management
- A uniform approach to treatment, including proper patient education and utilizing drugs with proven efficacy and minimal side effects, is recommended 6
- Continued activity, rather than bed rest, is recommended for acute low back pain 6
- Thermotherapy, cryotherapy, TENS, spinal manipulative therapy, and acupuncture may be used as adjuncts to improve acute low back pain 6