Bechara Y. Ghorayeb, MD, PA
Otolaryngology-Head & Neck Surgery                                                       Phone: 713 464 2614
1140 Business Center Drive, Suite 560
Houston, TX 77043                 www.ghorayeb.com


Mastoidectomy Informed Consent


Mastoidectomy is an operation to remove disease from the bone behind the ear, when medical management is inadequate. There need not be drainage or ear pain for mastoid disease to exist. Sometimes a mastoidectomy is required in order to gain better exposure to the middle ear and attic. Although complications do not often occur, they include persistent ear drainage, infection in the mastoid cavity, and hearing loss which may be permanent. Facial nerve injury (paralysis of the face on the side of the surgery) is a rare but potential hazard in mastoid surgery. There may be dizziness for a short time after surgery, but it is rarely permanent. Loss of taste on the side of the tongue usually lasts a few weeks but may be permanent. In extremely rare instances, brain infection (meningitis) has been known to occur. In certain instances, when the mastoid cavity is left open (as in a radical or modified radical mastoidectomy), the ear should be kept dry and swimming is not allowed.

I/We have been given an opportunity to ask questions about my condition, alternative forms of treatment, risks of nontreatment, the procedures to be used, and the risks and hazards involved, and I/we have sufficient information to give this informed consent. I/We certify this form has been fully explained to me/us, and I/we understand its contents. I/We understand every effort will be made to provide a positive outcome, but there are no guarantees.


_______________________________ ____________________________________________
Patient / Legal Guardian
____________________________________________________________________________
Witness

Date:___________________________          Time:___________________________


  www.ghorayeb.com