Cholesteatoma

Mr Wallace is a 34 year old man who has had a chronically discharging ear for 8 months despite oral and topical antibiotics. A CT temporal bone was performed and is provided for you. Please discuss the result with Mr Wallace and the like management plan.

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if he is happy to see you
  • Ask if he wants any family/friends present

Perception

  • Recap on past events – symptoms – hearing loss, tinnitus, vertigo, otalgia, otorrhoea, previous surgery, any other investigations
  • “Thank you for bringing me up to date.”

Invitation 

  • “Can I go over your CT scan findings with you now?”
  • “Is there anybody else you would like to be present?”

Knowledge

  • “Unfortunately it is not good news.”
  • “This shows that you have a collection of skin cells in you middle ear, know as a cholesteatoma” – Pause
  • Answer and questions they may have at this stage
  • Explain
    • Benign condition but can be locally destructive
    • No medical treatment for this condition
    • Surgery – called a mastoidectomy – is recommened to avoid complications if it is left alone. 
    • Explain mastoidectomy (link to mastoidectomy consent page) if they ask

Empathy

  • “I am sorry to have to give you this news today.”
  • “I can see this is a shock” Pause and wait

Strategy and Summary

  • Summarise consultation. Today we have talked about…. 
  • Offer chance to ask final questions
  • Offer leaflet on diagnosis and mastoid surgery 
  • Offer hearing aid if hearing impaired
  • Once again my name is…
  • Secretary number
  • Book an appointment for 1-2 weeks, time to think about their options. Mention that they can come with a friend or relative.

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