Pre-operative information in mastoidectomy: what about the facial nerve and hearing loss?

Facial nerve palsy and hearing impairment are accepted risks of mastoid surgery. However, at present there are no guidelines as to whether a patient must be informed of the potential risk to the facial nerve and hearing during mastoid surgery. Currently the law states that the surgeon should do what a 'reasonable doctor' would do under similar circumstances but exactly what this entails is not clear. A recent publication established that 16 per cent of British surgeons did not tell their patients about the risk to the facial nerve and 13 per cent about the risk of hearing loss. A survey of South African surgeons showed a different picture with only 57 per cent of surgeons informing their patients of possible facial nerve injury and 71 per cent about hearing loss. One of the reasons stated was that this information might deter the patient from having a necessary operation. This raises the question of excessive information disclosure and its possible legal consequences if excessive information leads a patient into making an unbalanced judgment owing to his/her lack of medical training, prejudices or personality. In this survey 25 per cent of South African surgeons have had patients refuse surgery after being informed of the risk to facial nerve and hearing. The decision whether to inform the patient about these risks should be individualized for every patient after the surgeon has audited his/her results and assessed the patients prejudices, personality and level of education.