A five-year-old male patient with a history of chronic otitis media, tympanic membrane perforation, and a large cholesteatoma of the right ear underwent a right tympanomastoidectomy with canal plasty. At the end of the procedure it was noted that the patient had "several small scattered regions on the posterior auricle including a focal region involving the incision" with "heat-induced injury from the microscope light intensity" and epidermal peeling. The areas were covered with Bacitracin ointment, and a protective dressing was applied.
The injury turned out to be full thickness, requiring skin grafting and a soft tissue flap to the posterior auricle.
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Do you believe there might have been medical error?
It should be well known to otolaryngologists and otologists in particular to be aware of the distance of the microscope from the patient (ear in this case) and the potential for transmission of heat and possible injury. Distance, light intensity, and heat should be monitored throughout the case. There may be other factors. I think this could rise to the level of a standard of care issue.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
It appears so based on the photographs if there is a lasting deformity of the ear and/or if subsequent significant medical care was required or additional surgical intervention.
What makes you a good expert for this case?
I am a Professor of Pediatric Otolaryngology with 19 years clinical experience. I have performed many otologic / ear cases. I have also been involved in a number of legal cases requiring records review, opinion, and in one case deposition testimony. I was involved last year in consulting on behalf of a plaintiff in the realm of pediatric ENT that lead to a multi-million dollar settlement. I think one should also consider the surgery center / hospital and microscope manufacturer potentially liable.
How often do you encounter cases similar to this one in your practice?
I do ear cases similar to this 25-30 times per year but, though aware of other similar injuries by others, haver not had any similar in my cases.
Do you believe there might have been medical error?
The injury occurred somehow, and if its consistent with a burn, then it happened from heat or friction (perhaps from the drill shaft). The heat could be electrical (eg electrocautery) or indeed from the microscope light being too intense for the distance to the patient.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
I think demonstrating what caused the injury is somewhat challenging, but something caused it during surgery.
What makes you a good expert for this case?
This is a commonly performed procedure in pediatric otolaryngology and this is what I do.
How often do you encounter cases similar to this one in your practice?
I've thankfully not seen a case like this. However, microscopes have guidance on them, the newer ones, about intensity levels and that is related to the heat that they generate.
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