B v Mr K ( ENT Surgeon)
Background to the Claim
On the 29th September 1999, the Claimant consulted her GP with a 5 month history of a blocked sensation and impaired hearing in both her ears but the left more than the right. There was no associated pain but there was a nasal discharge present. On examination both her ear drums were noted to be sucked in, particularly on the left side and polyps were described as being present in the nose, more so on the right than the left. A diagnosis of "glue ear" secondary to nasal polyps was made and treatment with a steroid nasal spray prescribed.
On the 27th October 1999 her GP treated symptoms of "chronic sinusitis and catarrah". Another entry of "chronic simple rhinitis" was made in the computer records for the 6th November 1999.
The nasal symptoms persisted but in addition the hearing in the left ear deteriorated further causing the Claimant to see her GP again on the 16th March 2000. Nasal congestion was noted by the GP as well as the hearing loss and it was thought that fluid was present in the left middle ear. The GP advised a decongestant remedy. Further review was to take place one month later.
On review on the 4th April 2000 the GP again recorded the presence of longstanding chronic nasal symptoms and "blockage" of the left ear. The Claimant was now weary of the persistence of the problems and requested specialist referral which was made to Mr K, Consultant ENT Surgeon by way of letter dated the 5th April 2000. At the time it was written that the GP was unable to detect fluid in the left middle ear.
Mr K saw the Claimant on the 25th April 2000. He noted the duration of left sided deafness as being 12 months with difficulties in speech discrimination manifest at meetings. There was no pain or tinnitus but the Claimant had been unsteady. The rhinitis was thought to be have been of non allergic origin in view of its lack of response to steroid nasal sprays. On examination the only abnormalities were some tenderness of the left side of the cervical spine and a slight tendency to move to the left on Unterberger's step test. A hearing test was performed and was reported as showing a "dip". However, it will be alleged that the graph also shows a bilateral low frequency rise in threshold more marked in the left ear than the right.
Mr K attributed the hearing problems to the "dip" at 6 khz and did not feel that a hearing aid would assist at that time. Nor did he feel that nasal surgery was appropriate and it did not arrange to see the Claimant again. The Claimant recalls that she was told by Mr K that her hearing loss was due to the effects of aging.
Over the course of the following months the Claimant's hearing and balance continued to deteriorate and were causing problems for her at work. In particular her balance became particularly troublesome after the first half of 2001. She returned to her GP on the 9th July 2001 complaining of headaches and dizziness. By which time she had also developed a tingling sensation in the tongue but did not report this to her GP at that time. The GP attributed these symptoms to stress and recommended a reduction in working hours. Nevertheless her symptoms did not improve during a holiday in September 2001 at which time headaches started to be increasingly troublesome and symptoms of facial numbness also developed.
On return from holiday the Claimant saw her GP on the 9th September 2001 when a request for an MRI scan was made as the GP thought the problems might be due to a vestibular Schwannoma. On the 29th September 2001 the GP again wrote to Mr K asking him to see the Claimant again because of the addition of symptoms of left sided facial numbness and "light headedness" to the previous hearing loss.
An MRI scan was performed on the 28th September 2001 and was reported as showing a "large" left sided vestibular Schwannoma with extensive brain stem compression and presumed compression of the left trigeminal nerve.
The Claimant saw Mr K again on the 2nd October and was informed of the result of the scan. A referral had already been made to Prof. R. The letter of referral did not mention the low frequency loss on the hearing testing and the Unterberger's test was described as virtually central. Prof. R examined the Claimant on the 5th October 2001 and hearing test performed. He considered there was an impending rise in pressure within the head and advised surgery to remove the tumour should be undertaken in the near future.
An operation had already been booked for the 30th October 2001.
The Claimant was experiencing severe pains in the head requiring her to take several pain killers a day. She was experiencing dizziness several times a day. The Claimant experienced a number of collapses including on one occasion a fall at home into the oven burning her left arm and leaving a scar.
The Claimant was admitted to the Manchester Clinic on the 29th October 2001 and underwent surgery the following day. She was discharged home on the 6th November 2001.
The Claimant was able to return to work on the 21st January 2002.
The Claimant continued to experience a number of problems post operatively including poor balance, abnormality of her sense of taste, headaches, profound left sided inner ear hearing loss and memory difficulties.
Allegations of Negligence
It was alleged that there was negligence in the treatment afforded to the Claimant by Mr K insofar as:-
a) whilst the initial presentation of the Claimant’s unilateral left sided hearing loss was obscured by the simultaneous presence of middle ear problems, by the time she was seen by Mr K in April 2000 there was a significant difference in the inner ear hearing between the two ears which required investigation namely an MRI scan to exclude a vestibular Schwannoma or other adjacent lesions. Mr K noted that the Unterberger step test had seen the Claimant veering slightly to the left. Furthermore, there is a dip in the Claimant’s hearing at 6 khz. The Claimant was informed by Mr K that her hearing loss was a result of age related deafness. It was be alleged that this was not tenable because of:-
- the Claimant’s age
- age related deafness is usually fairly symmetrical between the two ears
- the raise in threshold at 6khz and recovery at 8 khz is characteristic of noise exposure but not of age related deafness
- the low frequency hearing loss is not at all the pattern of that associated with age
b) It was alleged that the failure to instigate MRI scanning meant the standard of care afforded to the Claimant by Mr K fell below an acceptable standard.
Causation
Had an MRI scan been carried out in April/May 2000 the Claimant would have proceeded to exicision of the tumour soon thereafter. Early diagnosis would have spared the Claimant the progression of symptoms which occurred in the period up to her surgery on the 30th October 2001.
Settlement
The case was settled and Mrs B obtained £12,500.00 in compensation.
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