Ear Osteoma Surgery Leads to Facial Paralysis

This case involves a sixty-eight-year-old male who had an osteoma in his external auditory canal for several years. It did not compromise his hearing when diagnosed, but he eventually lost all hearing ability in the afflicted ear due to a maximum conductive hearing obstruction. The patient underwent a procedure to resect the mass and was noted to have facial paralysis in the immediate, postoperative period. The medical records acknowledge the nerve paralysis but contributed it to postoperative swelling. After the postoperative swelling subsided, the patient still experienced paralysis and had severe problems with vertigo, and has had to have numerous canalith re-positioning procedures. The plaintiff retained an expert witness in audiology and otolaryngology for this case.

Question(s) For Expert Witness

1. Was this surgery absolutely indicated and, if so, are these accepted complications of the procedure?

Expert Witness Response E-001049

A well trained ENT should be able to perform this surgery adequately. It is not a run-of-the-mill case, as they are uncommon, but the indications for the surgery are there (conductive hearing loss secondary to the osteoma). Nerve dysfunction is a possible complication (either through post-op edema or damage in the surgery) and nerve monitoring is typically used in these cases to help limit any possibilities of post-op complications. If there were post-op complications that were attributed to a deviation of the standard of care, then a consult should have been considered.