Tympanoplasty Procedure Causes Severe Hearing Impairment

ByWendy Ketner, M.D.

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Updated onSeptember 27, 2018

Tympanoplasty Procedure Causes Severe Hearing Impairment

This case involves a ten-year-old female who underwent a complicated tympanoplasty. During the procedure, the otolaryngology/audiology surgeon encountered a high jugular bulb and perforated through the vessel, which resulted in significant bleeding. During the recovery period, the patient experienced conductive hearing loss that did not improve over time. The patient underwent a re-exploration of the ear that revealed a damaged stapes and incus. An attempt was made to remove scar tissue around the site of the fracture to re-elevate and re-position the bones. The patient had to undergo an additional surgery for the placement of a prosthesis that eventually became dislodged. After the last procedure, the patient has had some improvement in her hearing but is still significantly hearing impaired.

Question(s) For Expert Witness

1. What are the recognized complications of this procedure and why did this patient experience a decrease in hearing ability?

Expert Witness Response E-001041

inline imageComplications of the surgery include recurrence of the perforation, tympanic membrane retraction, otorrhea, cholesteatoma development, persistence or worsening of any conductive hearing loss, sensorineural hearing loss (rare), and taste disturbances. Post-auricular incisions are at risk for hematoma, and a mastoid pressure dressing is recommended for the first postoperative night. Outcomes can be optimized by a proper and detailed preoperative assessment and the careful construction of an effective surgical plan. The graft can fail because of infection, failure to pack the graft securely in place, technical error, failure to clear mastoid and middle ear disease, and because of excessive bleeding during the procedure. Excising all tympanosclerosis at the edge of the perforation, so as to allow vascularized perimeters to incorporate the graft, is critical.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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