Myringoplasty

Setting

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

  • Ask if the patient is happy to see you


Perception

  • 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


Invitation 
  • 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’


Knowledge

  • 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.

      • Taste disturbance

      • Hearing loss

      • Tinnitus

      • Vertigo

      • Facial paralysis

      • Graft failure (larger perforations have a higher failure rate)

      • Ear dressing reaction

    • Individual risks to patient


 

Post op


  • Most likely to be day case procedure/overnight stay

  • May have ear packing– this would be removed later in clinic

  • Important not to do heavy lifting, sneeze, blow nose

  • May need to take course of antibiotics

  • Time off work – give sick note

  • Contact department/attend A&E if: ear discharge, fever or pain not responding to analgesics


Follow up advice


    • See back in clinic in X weeks/months


Summary


  • 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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