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An unexpected mass

01 January 2008

Mrs H was a 45-year-old supervising school librarian. She went to see her GP, Dr P, and admitted she had been having hearing difficulties for more than eight months and had been suffering with quite bad right-sided earache too. Although he could find no abnormality on examination, Dr P referred Mrs H to ENT surgeon, Dr J.

Dr J decided to do an exploratory tympanotomy on Mrs H as a day-case. On the morning of the surgery, Dr J went through the standard hospital consent form with Mrs H. There is no record of any questions that she asked during that discussion.

Fifteen minutes into Mrs H’s surgery, Dr J discovered the cause of her symptoms. A glomus tympanicum tumour was occupying most of Mrs H’s middle ear. Dr J considered how to proceed and opted to remove the vascular mass while Mrs H was still under anaesthetic.

During the removal of the tumour, Mrs H suffered serious haemorrhaging and Dr J had to occlude her anterior tympanic artery.

Dr J explained the situation to Mr and Mrs H as soon as she recovered from her general anaesthetic. Over the next few days, Mrs H noticed her deafness was much worse after the operation than it had been before and she developed significant vertigo. Her symptoms meant she eventually had to leave her position as supervising librarian at the school.

Mrs H subsequently brought a claim for damages against Dr J.

Expert opinion

An ENT expert was critical of Dr J’s decision to remove the glomus tympanicum tumour without arranging CT or MRI scanning prior to the procedure. He also criticised Dr J for removing the tumour without Mrs H’s consent. She had understood that her operation was purely exploratory to investigate the cause of her deafness. She claimed that she had stressed to Dr J her anxiety about losing her hearing, although there was no record of this.

The claim was settled for a moderate sum.

Learning points

  • Obtaining appropriate consent for any procedure is essential. The possibility of additional problems coming to light during a procedure should be discussed with the patient as part of this process. Consent should be obtained for treatment of any specific problems that may emerge during the surgery.
  • If a patient has specified they would rather a procedure didn’t go ahead in the event of certain clinical findings, the patient’s decision must be recorded and respected.
  • If you have not explained to the patient that a certain situation may arise and the options for continuing in this eventuality are not fully described, you should not perform the procedure unless it is an emergency. To do otherwise risks a complaint to the your body or a claim in negligence.
  • If consent cannot be obtained in an emergency situation, treatment may be provided if it is immediately necessary to save life or prevent significant deterioration in health. The patient should then be told what has been done, and why, as soon as possible.

Further information

Savage J R et al, Litigation in Otolaryngology – Trends and RecommendationsJ Laryngol Otol, 120(12):1001–4. (2006)