ARTICLE ID 32602
$________ - MEDICAL MALPRACTICE - NEGLIGENT PERFORMANCE OF EAR IRRIGATION BY FAMILY PHYSICIAN - RUPTURE OF TYMPANIC MEMBRANE, FRACTURE TO STAPES AND INNER EAR FISTULA - PERMANENT 30% LOSS OF HEARING IN ONE EAR - TINNITUS - PERIODIC BOUTS OF VERTIGO - PLAINTIFF ABLE TO RETURN TO FINANCIAL ANALYSTS' CAREER.
This was a medical malpractice action in which the male
plaintiff, age 26 at the time, contended that the defendant
family practitioner, who was using a syringe to irrigate the
plaintiffs left ear which had become clogged during vacation,
causing discomfort and affecting his hearing, negligently failed
to allow for drainage of the water used during the irrigation
process, rupturing the tympanic membrane, fracturing the stapes
and causing an inner ear fistula. The plaintiff contended that
despite repair surgery, he will permanently suffer a 30% hearing
loss in the ear, recurring episodes of vertigo and continual
tinnitus. The repair surgery was performed approximately 1 1/2
years later, but there was no claim that any delay changed the
course, which the plaintiff contended would have occurred upon
the initial injury irrespective of the treatment then given.
The plaintiff related that after he returned home from vacation
with a clogging sensation in his ear and some difficulties
hearing, he visited the defendant, his family physician, who was
a member of the defendant group. The defendant utilized a syringe
containing a bulbous or olive-shaped tip during the irrigation.
The plaintiff contended that although acceptable, the utilization
of such a bulbous tip requires additional care be used due to the
risk of the tip obstructing the flow of water out of the ear
during the irrigation process. The plaintiffs expert maintained
that the use of a slender tip, such as the type he utilizes in
his practice, would obviate the hazard.
The plaintiff contended that during the irrigation, he suddenly
heard a loud booming noise and simultaneously felt severe pain
and nausea. The plaintiffs expert contended that these signs
reflected rupturing of the tympanic membrane and the fracturing
of the stapes, which the plaintiff contended occurred during the
irrigation and stemmed from the excess pressure of the water
build-up, ultimately leading to the fistula. The plaintiff
contended that he immediately developed vertigo, tinnitus and
that his hearing was diminished. The plaintiffs expert
maintained that if the defendant had been sufficiently careful to
avoid inserting the syringe too deeply and if he had placed it at
an appropriate angle, the water would have been able to escape
and the injuries would not have occurred. p 7 3
The defendant denied that the irrigation was performed improperly
or that significant injury and the rupture occurred during the
irrigation. The defendants expert contended that the literature
reflected that a rupture would not occur during the performance
of such an irrigation. The plaintiff countered that there was no
evidence that the article referred to an irrigation device other
than the slender tip type, arguing that the defendants position
should be rejected.
The defendant further contended that a documented infection of
the middle and inner ear caused the rupture a few days later and
that such a complication occurred in the absence of negligence.
The evidence disclosed that when the plaintiff complained of the
pain and heard the loud noise, the defendant immediately brought
him to one of the ENT members of the group, who noted a small
laceration in the outer area of the ear canal, which the
defendant stressed, can occur in the absence of negligence. This
ENT did not observe a perforation and prescribed antibiotic ear
drops to prevent infection. The defendant contended that although
this ENT did not observe any signs of impending infection, the
excessive build-up of wax would be likely to cause the beginning
of an infection and that when combined with the small laceration
which occurred during the irrigation, culminated in the
significant infection that caused the injuries, notwithstanding
the use of antibiotics.
The evidence disclosed that later that night, the plaintiff
visited the emergency room and the emergency room physician
contended that he detected the perforation and instructed the
plaintiff to visit an ENT the following day. The plaintiff
returned to the group, saw the second ENT specialist, "Dr. C,"
and this physician, who did not believe that a perforation had
occurred, did diagnose a middle ear infection and continued
The plaintiff related that he continued to suffer severe pain,
returned the following day and saw a third ENT physician, "Dr.
W." The plaintiff contended that this physician diagnosed the
rupture and advised him that the only treatment would be to
continue the antibiotics. The defendant denied that this
physician had, in fact, detected a rupture and pointed to the
absence of any mention of such finding in his records. The
plaintiff countered that the defendant failed to produce this
physician and argued that if the plaintiffs testimony regarding
advisements given by this physician were inaccurate, the
defendant would have produced this physician to rebut the
plaintiffs factual testimony. The defendant countered that the
plaintiff could have produced this doctor as well since he was
The plaintiff, who returned the following day, was seen again by
Dr. C., who noted that the ear was entirely closed, that a
rupture was possible and who advised the plaintiff to continue
the antibiotic therapy and return in a few days. The plaintiff
related that he then decided to seek a different group and saw
the non-party subsequent treating ENT specialist four days later.
This physician diagnosed the large perforation and treated him
conservatively for several months, ultimately resolving the
peroration by cauterization. p 7 3
The plaintiff contended that his balance difficulties, hearing
loss and tinnitus, which commenced immediately after the
irrigation, have continued and that when the symptoms did not
improve after a few months, the plaintiff was referred to the
subsequent treating otolaryngologist with a subspecialty in
balance disorders. This physician performed surgery and noted
that in addition to the stapes having fractured, an inner ear
fistula had also formed which he closed with a graft. The
plaintiff contended that although the balance difficulties
improved substantially, he continues to suffer episodes which
last several weeks every few months. The plaintiff maintained
that the episodes occur more frequently after significant
exertion and sudden movement.
The plaintiff contended that he has been forced to give up
favored activities such as jogging and working out and also
maintained that he is very limited in the extent to which he can
play with his daughter, age 2 1/2 at trial. The plaintiffs wife
was in her sixth month of pregnancy with their second child at
the time of the trial. The plaintiff also contended that he
continues to suffer constant tinnitus, which is extremely
troublesome, as well as a 30% hearing loss in the ear. The
plaintiffs expert maintained that these symptoms are permanent
in nature and would have developed to the same extent even if the
rupture was immediately detected.
The plaintiff had also contended that the ENT physician who saw
him on the day of the irrigation had deviated in failing to
observe the perforation and prescribe antibiotics. The
plaintiffs experts conceded that the course of treatment would
not have changed even if such antibiotics had been prescribed at
the time and the plaintiff withdrew the claim against this
The plaintiff, who works as a financial analyst, was able to
return to work and made no income claims.
The jury found that the defendant family physician was causally
negligent and awarded $________ and $________ in medical bills. The
jury also declined to render a per quod award.
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