PREOPERATIVE INFORMATION IN MASTOIDECTOMY - WHAT ABOUT THE FACIAL-NERVE AND HEARING-LOSS

Facial nerve palsy and hearing impairment are accepted risks of mastoi d surgery. However, at present there are no guidelines as to whether a patient must be informed of the potential risk to the facial nerve an d hearing during mastoid surgery. Currently the law states that the su rgeon should do what a 'reasonable doctor' would do under similar circ umstances but exactly what this entails is not clear. A recent publica tion established that 16 per cent of British surgeons did not tell the ir patients about the risk to the facial nerve and 13 per cent about t he risk of hearing loss. A survey of South African surgeons showed a d ifferent picture with only 57 per cent of surgeons informing their pat ients of possible facial nerve injury and 71 per cent about hearing lo ss. One of the reasons stated was that this information might deter th e patient from having a necessary operation. This raises the question of excessive information disclosure and its possible legal consequence s if excessive information leads a patient into making an unbalanced j udgment owing to his/her lack of medical training, prejudices or perso nality. In this survey 25 per cent of South African surgeons have had patients refuse surgery after being informed of the risk to facial ner ve and hearing. The decision whether to inform the patient about these risks should be individualized for every patient after the surgeon ha s audited his/her results and assessed the patients prejudices, person ality and level of education.