This case involves a ten-year-old female who underwent a complicated tympanoplasty. During the procedure, the otolaryngology/audiology surgeon encountered a high jugular bulb and perforated through the vessel, which resulted in significant bleeding. During the recovery period, the patient experienced conductive hearing loss that did not improve over time. The patient underwent a re-exploration of the ear that revealed a damaged stapes and incus. An attempt was made to remove scar tissue around the site of the fracture to re-elevate and re-position the bones. The patient had to undergo an additional surgery for the placement of a prosthesis that eventually became dislodged. After the last procedure, the patient has had some improvement in her hearing but is still significantly hearing impaired.
Question(s) For Expert Witness
- 1. What are the recognized complications of this procedure and why did this patient experience a decrease in hearing ability?
Expert Witness Response E-001041
Complications of the surgery include recurrence of the perforation, tympanic membrane retraction, otorrhea, cholesteatoma development, persistence or worsening of any conductive hearing loss, sensorineural hearing loss (rare), and taste disturbances. Post-auricular incisions are at risk for hematoma, and a mastoid pressure dressing is recommended for the first postoperative night. Outcomes can be optimized by a proper and detailed preoperative assessment and the careful construction of an effective surgical plan. The graft can fail because of infection, failure to pack the graft securely in place, technical error, failure to clear mastoid and middle ear disease, and because of excessive bleeding during the procedure. Excising all tympanosclerosis at the edge of the perforation, so as to allow vascularized perimeters to incorporate the graft, is critical.