• WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)

  • Ask if the patient is happy to see you


  • Check what the patient understands so far

  • What symptoms are they having and what treatments have they tried so far

  • Offer options including surgery and alternatives

  • Ask if they would like to know more about the operation

  • Ask permission to take consent

  • Explain you will outline the procedure, alternatives, risks and benefits, recovery time.

  • ‘If at any point you have any questions feel free to interrupt me, but I’ll also ask you afterwards if you have any questions’


  • Explain procedure

  • Draw diagram

  • Explain alternatives

  • Intended benefits

  • Potential risks and complications

    • With any operation, risk of bleeding, infection, pain, risk of GA – anaesthetist will be able to go through in more detail. See General Risks below

    • Also specific risks associated with this operation. 

      • Hearing loss

      • Total and permanent loss of hearing

      • Tinnitus

      • Vertigo 

      • Altered taste

      • Facial nerve weakness (temporary/permanent) 

      • Temporary bruising to face from facial nerve monitor

      • CSF leak

      • Meningitis 

      • Numb pinna

      • Need for long term follow up

      • Meatoplasty

      • Second look surgery 

      • Hearing reconstruction is a secondary aim. May have to be staged and not always possible.

      • Dressing reaction (BIPP)

    • Individual risks to patient


Post op

  • Most likely to be a day case procedure

  • May have packs in ear canal – these would be removed later in clinic

  • Head bandage can come off the following morning

  • Wound care advice

  • Avoid heavy lifting, sneezing (sneeze with mouth open), blowing nose

  • Time off work – give sick note 2 weeks

Follow up advice

  • See back in clinic in 2-3 weeks for dressing removal


  • Summarise consultation

  • Offer opportunity to ask questions

  • Offer patient information leaflet

  • Thank patient, wash hands and close

General Risks

  • Bleeding and bruising

  • Infection

  • Pain

  • Scar

  • Risk of general anaesthesia

  • Further surgery

  • Return to theatre

  • Recurrence

  • Suboptimal outcome

  • Numbness

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