Ryan K. Sewell

Hearing loss resulting in malpractice litigation: What physicians need to know

To evaluate the relationship between hearing loss and malpractice litigation.

Medical malpractice and sinonasal disease.

Objective Sinonasal disease is a common diagnosis that is encountered by nearly all specialties. This study examines medical malpractice trends in sinonasal disease. Methods One hundred fifty-two malpractice cases involving sinonasal disease between 1988 and 2005 were obtained from a computerized legal database. Results Defendants prevailed in 62 percent of the cases with a median monetary award of

Retropharyngeal thymus and parathyroid gland: a case report.

650,000. Younger patients prevailed at a higher rate than did older patients (50% vs 35%), and men had a higher median award than did women (

FESS Malpractice Risk Factors Identified Using Case-Controls

1.0 million vs

The Benefit of Brain MRI in the Evaluation of Pediatric Dysphagia

314,000). These results approached but did not reach statistical significance (P = 0.09, P = 0.06). Otolaryngologists were the most commonly sued specialty (56%). The most common complications of endoscopic sinus surgery included cerebrospinal fluid leak, orbital trauma, and anosmia. Cancer plaintiffs received the highest median award of

11:14: Medical Malpractice and Sino-Nasal Disease

1.5 million. Conclusions Physicians must be diligent in forming differential diagnoses, and surgeons must ensure informed consent is obtained and documented. Future studies should continue to identify risk management strategies and areas for malpractice reform.

Osteogenesis Imperfecta and Hearing Loss

Cervical ectopic thymus occurs when thymic tissue arrests during its embryologic descent through the neck to the upper mediastinum. Most often it presents as an asymptomatic neck mass. Rarely does it present with airway compromise, particularly in neonates. A neonate presented with a retropharyngeal mass causing dynamic upper airway obstruction, mimicking a venolymphatic malformation. Ultimately this proved to be aberrant ectopic thymus with an associated parathyroid gland. While there have been isolated reports of thymus or parathyroid in the retropharyngeal space, none of the prior reports found both within the same patient.

Chapter-047 Medical Malpractice and Head and Neck Cancer

Objective: Complications related to functional endoscopic sinus surgery are well documented. These complications will, in some instances, lead to claims of medical malpractice. This study seeks to preoperatively identify both patient and procedural characteristics which are more likely to result in adverse events. This may then allow them to develop risk management strategies as they pertain to functional endoscopic sinus surgery. Method: Case control study of The Doctors Company closed claims involving functional endoscopic sinus surgery between 2005-2009. These were then compared with a control group of 196 survey responses sent by The Doctors Company in 2011 to insured otolaryngologists. Results: A total of 17 claims were closed from 2005-2009. There was no significant age difference in the claims group and controls. Age greater than 60 inferred a 2.8-fold increase in risk of a closed claim (P = .09). The lack of polyps was associated with an increased risk of a claim (P = .04). All claims involved surgery that included at least an ethmoidectomy. The use of powered instrumentation was not statistically significant. Revision surgery was associated with a 13-fold increase in risk of a claim (P = .05). Conclusion: The present article illustrates the utility of a case control method to identify scenarios that are more likely to result in malpractice claims. Identification of risk factors preoperatively has the potential to help avoid complications and, thus, lawsuits. This methodology may be useful when examining other surgical procedures as well.

Medical malpractice and transoral robotic surgery: Evaluation and some preemptive thoughts

Objective: Determine rates of brain MRI abnormalities for dysphagia in a pediatric aerodigestive center. Examine trends in swallowing improvement based on brain MRI pathology and syndromic status. Recognize the incidence of Chiari malformations and the association with dysphagia. Be able to counsel families regarding likelihood of swallowing improvement based on abnormal MRI. Method: Retrospective review of 222 pediatric medical records (2001-2010) enrolled in an aerodigestive clinic. Swallow studies and brain MRI reports were reviewed. Patients were subdivided into syndromic and nonsyndromic, n = 62, 159. All patients with MRI for dysphagia were analyzed statistically for brain abnormalities, Chiari malformation, correlating with swallowing improvement and resolution. Results: Of 222 children with dysphagia 45 had brain MRI for dysphagia. A total of 14 had abnormalities. Eleven, 24%, were nonsyndromic with abnormal MRI. Two out of 11 were diagnosed with Chiari comprising 5% of MRIs performed for dysphagia in nonsyndromic children. One Chiari I patient did not undergo surgery and demonstrated improvement. No Chiari patients had resolution of dysphagia, yet 50% improved P = .486. MRI did not correlate with symptom resolution. Nonsyndromic with abnormal MRI for dysphagia displayed 60% improvement vs 56% improvement with normal MRI, P = 1.0. Resolution rates were similar for patients with abnormal MRI (18% resolution rate) and normal MRI (22% resolution rate), P = 1.0. Conclusion: At our institution children with persistent dysphagia undergo brain MRI to exclude Chiari malformation. Two malformations were diagnosed (5%), supporting MRI in dysphagia evaluation in diagnosing Chiari. However, it does not support MRI utility in predicting resolution, as there was no difference statistically between the brain MRI groups outcome.

Injuries in Sinus Surgery

OBJECTIVES: Examine litigation trends for injury claims related to sino-nasal disease. METHODS: A retrospective review of 70 jury verdict or settlement results was obtained from a computerized database. Reviews compiled data on plaintiff age and gender, defendant specialty, surgical or medical complications and resulting morbidity, claimed basis for malpractice claim, state jurisdiction, year case decided, and amount of verdict or settlement. RESULTS: Defendants prevailed in 73% of the cases. Average awards and settlements were