Informed Consent 
Tympanoplasty or reconstruction of the middle ear hearing mechanism serves the purpose of rebuilding the tympanic membrane and/or middle ear bones. An excellent result may be expected in 80-90% of cases, failure to improve is not a complication. Success depends almost as much on the ability of the body to heal and preserve the reconstruction as it does on the surgeon's skill. Fortunately, even those cases that fail may be revised and have the same high degree of expected good result. There are, nevertheless, some complications that do occasionally occur. Further hearing loss (rarely total) happens less than 10% of the time when the middle ear bones are rebuilt, and for that reason ossiculoplasty is not advised unless hearing is poor. Hearing loss is uncommon if the operation is limited to repairing the typmanic membrane. Injury to the facial nerve as a result of this surgery is rare. There is a slightly greater risk when mastoidectomy is also performed, but once again, the most experienced surgeons may only encounter this complication once or twice in a career. As a general statement, complete success in restoring hearing without complication is related to the severity of the disease present before surgery, and those are the cases that have the highest priority for surgical management. Loss of sense of taste on the side of the tongue may occur. It is usually only a minor inconvenience for a few weeks. Persistent post operative dizziness is almost unheard of after surgery limited to the repair of a tympanic membrane perforation and uncommon after rebuilding the ear bones. Unless control of infection or concern of cholesteatoma (as skin in the middle ear exists) is the reason for surgery, tympanoplasty is an elective procedure. Use of a hearing aid may be an alternative to reconstructive surgery. If the typmanic membrane perforation is not repaired, ear plugs are recommended to protect the middle ear from contamination when bathing. This may help to prevent infection and its complications.

​I have discussed the risks, benefits and alternatives of the procedure/treatment to the patient/patient representative. I answered the patient’s/patient’s representative’s questions regarding the procedure/treatment.

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 

Date:___________________________          Time:___________________________ 

Bechara Y. Ghorayeb, MD   
1140 Business Center Drive, Suite 560   Houston, Texas 77043  - For appointments, call: 713 464 2614