Hi,
I went to see the doctor in ENT for my middle ear infection and was told I need a surgery for my cholesteatoma. I have three questions:
1) How can I find the best doctor for my surgery or second opinion? I live in Boston, MA area. Should I find a otologist/neurotologist, or otolaryngologist?
2) My doctor told me he has 9 years' surgery experience on cholesteatoma, average once a month, all of which are successful and patients do not have significan long-term problem, no law suits. Is this doctor experienced enough? What other background should I check?
3) I read the info in internet and learned a lot of risks involved with such surgery. But seems to me my doctor's success in such surgeries proves that it is not that risk at all. Am I right? Can you tell me more on those risks (with percentage)?
Thanks a lot for your advice,
Reply: -----------------------
1) It is not absolutely necessary to see an otologist/neurotologist for surgical treatment of a cholesteatoma. A board-certified otolaryngologist in many, if not most cases is quite appropriate. It may be true that an average otologist/neurotologist may have more experience with this type of surgery than an average general otolaryngologist because of the fact that the otologist's practice is limited to the diagnosis and management of ear disease. However this does not imply that good outcomes are necessarily dependent on being treated by an otologist versus an otolaryngologist. There are many factors which must be considered in determining the best choice in specialists - reputation amongst peers, nursing staff, and patients; personal experience and training; personality (eg bedside manner); accessability, etc. The best sources of information are your primary care physician; family, friends, or acquaintances who have had pertinent experiences; local medical society; as well as an initial personal consultation with the specialist in which it is perfectly appropriate to inquire as to his/her background and experience.
2) There is no correct answer to the question as to what is the appropriate frequency of surgical experience that corresponds to best chance of successful outcome. It is reasonable to assume however that the more frequently one performs a particular operation, the more adept he/she will be at it. In the case of cholesteatoma surgery, the experience of the surgeon you have seen would seem to be quite adequate.
3) The risks of cholesteatoma surgery include injury to the facial nerve which courses through the mastoid and middle ear which can result in paralysis of the facial muscles of expression; injury to the inner ear which can result in deafness or vertigo; diminished hearing; infection; or recurrence of cholesteatoma amongst other risks. Surgical risks however are increasingly minimized by technological advances including intraoperative facial nerve monitoring, high-powered and highly illuminated magnification, surgical instrumentation etc. Additionally, one must weigh the potential risks of surgery versus the risks of not treating the cholesteatoma - untreated, the cholesteatoma can erode the bones of hearing, injure the facial nerve, damage the inner ear, or extend into the cranial cavity.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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