Settlement of fatal claim from cholesteatoma arising out of failure of ENT team to investigate

We settled a claim against Medway NHS Foundation Trust relating to the death of a 30 year old man from an undiagnosed cholesteatoma, a bag of dead tissue in the ear which if left untreated rots away the ear and the linings of the brain.

The deceased had a history of problems with his ears since childhood, including bilateral secretory otitis media for which he required treatment. In May 2006 he experienced smelly purulent discharge from his right ear which his GP treated conservatively. The treatment failed and the GP made a referral to Medway Hospital Ear Nose and Throat (ENT) team in July 2007. The deceased was first seen in September 2007 when the problems were noted and he was offered a further conservative treatment in the form of Gentamicin drops. At the next review, four weeks later, the symptoms remained unaltered but further drops were prescribed.

By the time of the review on 14 December 2007, the deceased had worrying symptoms. The history of unresolved right-sided foul smelling otorrhoea, despite repeated courses of topical and systemic antibiotics, was noted. The doctor queried whether he might have an underlying cholesteatoma and quite rightly arranged an urgent CT scan. The CT scan was carried out on 2 January 2008. There appeared to be a soft tissue abnormality of the right ear and the radiologist concluded that it was not possible to exclude a right cholesteatoma.

The deceased was offered appointments in April and May to discuss the findings but was unable to attend and was unaware of any urgency. When he was eventually seen on 11 July 2008, the offensive right ear discharge continued and, despite the findings of the CT scan, the doctor decided that he would prescribe further ear drops and review one month later. At the review on 8 August 2008, the discharge was thought to be less and further drops were given.

Unfortunately, the deceased collapsed at home on 12 December 2008. He was taken to Medway Hospital and a CT scan was undertaken. The appearances were noted as likely to be due to acute cerebritis due to intracranial extension of infection from the right middle ear. His condition deteriorated and he was transferred to King's College Hospital Neurosurgery Department two days later but sadly died on 19 December 2008.

The clinical negligence team obtained expert evidence from an ENT expert who was very critical of the management that had been provided. He advised that a cholesteatoma was a serious condition which can only be treated surgically. There had been repeated attempts at conservative treatment, all of which had failed. It was, therefore, illogical to continue with conservative treatment and it was mandatory to list for surgical exploration at least by the time of the appointment on 11 July 2008. If this had happened, then the cholesteatoma could have been treated and the deceased would have survived. The case was presented to the trust which strongly defended the matter at the protocol period stage and throughout court proceedings and the build-up to trial. Just three weeks before trial, the trust agreed to settle the matter.

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