EN2.9 | ENT Surgical Consent Counselling — Summary & Reflection

KEY TAKEAWAYS

Valid surgical consent requires: capacity (mental competence), voluntariness (no coercion), and information (procedure, benefits, specific risks, alternatives). Six-part framework: opening → indication → procedure (lay language) → benefits (realistic) → risks (specific + severity, not just frequency) → alternatives (including no treatment). Operation-specific risks: tympanoplasty = graft failure, SNHL (rare), chorda tympani injury; mastoidectomy = facial nerve injury (most feared, <1%, must be named explicitly), SNHL, CSF leak, meningitis; FESS = orbital injury (lamina papyracea breach), CSF leak; adenotonsillectomy = primary haemorrhage (<24h) and secondary haemorrhage (days 5–10, most common and most dangerous — warn to return immediately if bleeding); tracheostomy = tube displacement, haemorrhage, tracheomalacia. Refusal of consent must be respected; document the informed nature of the refusal. Secondary haemorrhage after tonsillectomy (days 5–10) and facial nerve injury in mastoidectomy are the two most examination-critical risk disclosures in ENT consent.

REFLECT

Reflect on a consent discussion you have observed in any surgical posting. Was the risk disclosure specific (named risks with frequency and consequence) or generic ('there may be complications')? Did the surgeon ask the patient to summarise their understanding? Did the patient seem genuinely informed, or did they sign the form because they felt they were supposed to? The legal standard for consent is not 'patient signed the form' — it is 'patient understood what they were consenting to.' As you prepare for clinical practice, commit to this higher standard: give every patient the time to understand, the language to comprehend, and the respect to decide freely.