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of litigation in sinonasal disease treatment, understand the legal
grounds where they are most vulnerable, promote a safer prac-
tice, and potentially improve patient care.
Methods
Two computerized legal databases (Westlaw, Thomas
Reuters, New York, New York; LexisNexis, a division of
Reed Elsevier, Inc, Amsterdam, the Netherlands) were
searched for the term
medical malpractice
in conjunction
with several terms dealing with the practice of otolaryngol-
ogy and sinonasal disease for the past 10 years (2004-2013).
Terms searched included
anosmia, cerebrospinal fluid leak,
deviated septum, epistaxis, ethmoidectomy, fungal sinusitis,
maxillary antrostomy, nasal cancer, nasal obstruction, nasal
polyp, orbital injury, paranasal sinuses, rhinologist, septo-
plasty, sinus surgery, sinusitis, sinusotomy, sphenoidostomy,
turbinate reduction
, and
vision loss
. Westlaw and
LexisNexis are similar databases requiring a subscription
that contain jury verdict reports from all 50 states. These
reports are submitted voluntarily by attorneys and typically
contain the jurisdiction, names of attorneys and expert wit-
nesses, demographic information, verdict, award amount,
and summary of the case. The Westlaw database has previ-
ously been used in multiple otolaryngology medical mal-
practice analyses including otology,
6
hearing loss,
7
corticosteroid use,
8
facial plastic surgery,
9
facial nerve
paralysis,
10
iatrogenic tracheal stenosis,
11
iatrogenic cranial
nerve injury,
12
iatrogenic cerebrospinal fluid (CSF) leak,
13
iatrogenic orbital injury,
14
and sinonasal disease.
15
Because no protected patient information was used, no
institutional review board review was sought. Data
extracted from the cases included plaintiff gender, present-
ing complaint, practice setting, type of malpractice alleged,
alleged injury, verdict, and amount of award or settlement
rewarded.
Results
The search identified 26 cases involving sinonasal disease
and otolaryngologists from 2004 to 2013. LexisNexis pro-
duced 2 additional cases not found in the Westlaw database.
The cases involved 19 males and 7 females. Eighteen cases
were in the private practice setting, and 6 involved an aca-
demic medical center. Of the 26 cases, 15 had complete
results, and the verdict or outcome was known in 18 of the
cases. Defendants prevailed in 72% (13/18) of these cases
and the plaintiff prevailed in 16% (3/18). Of the 3 cases
won by the plaintiff, 2 had published award amounts of
$300,000 and $150,000. All 3 of these cases were in the pri-
vate practice setting. Settlement was reached in 2 cases with
a monetary award of $250,000 and $175,000. In the 8 cases
in which verdicts or outcomes were not published, initial
summary judgment was denied. Summary judgment is a
court order ruling that no factual issues remain to be tried
and therefore a complaint can be decided on certain facts
without a trial.
The most common presenting complaint or reason for
treatment was chronic sinusitis (42%) followed by nasal
obstruction (27%;
Table 1
). The type of malpractice was
divided into 7 categories. The most common allegation was
negligent technique, followed by lack of informed consent.
Other allegations included failure of surgery, wrongful
death, surgery not indicated, failure to diagnose, and injury
unrelated to surgery (
Figure 1
). Four cases alleged CSF
leak, and 4 cases alleged wrongful death. Other alleged inju-
ries included visual impairment, meningitis, nasal obstruc-
tion, headache, recirculation, anoxic brain injury, bleeding,
orbital hematoma, infection, anosmia, burning mouth syn-
drome, foreign body in abdominal fat graft site, and need
for additional surgery (
Table 2
).
The alleged injuries in the wrongful death cases included
carotid artery injury, respiratory failure due to postsurgical
pneumonia, and 2 cases involving failure to diagnose sino-
nasal cancer. The carotid artery injury case was won by the
plaintiff, and the award amount was not published. The
respiratory failure case and 1 of the failure-to-diagnose sino-
nasal cancer cases ended with a defendant verdict. The
other failure-to-diagnose case had initial summary judgment
denied, and the further outcome of the case was not pub-
lished. The 2 other cases won by the plaintiff involved the
same physician, and both cases alleged failure of surgery,
recirculation, and medical fraud.
There were 7 cases that alleged lack of informed consent.
Four of these cases were in private practice, and 3 were in an
academic setting. Three cases were won by the defendant,
and 4 cases had initial summary judgment denied and the
outcome was not published. Alleged injury in cases won by
Figure 1.
Type of malpractice.
Table 1.
Presenting Complaint.
Presenting Complaint
No. of Cases
Chronic sinusitis
11
Nasal obstruction
7
Sleep apnea
3
Headache
2
Acute sinusitis
1
Nasal polyps
1
Allergic fungal sinusitis
1
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