Perforated Sinus During ENT Surgery Resulting in Brain Damage

The McLamphy Case

A 71-year old patient underwent a sinus endoscopy surgery. It was performed by an otolaryngologist, otherwise known as an ENT (ear, nose and throat) doctor. During surgery, the ENT unknowingly perforated the sinus causing air in the brain. Although that can be a known risk of the surgery, if timely recognized and treated, typically no harm results. In this case, although there were classic signs of a sinus puncture, the patient was nonetheless discharged home, later found with paralysis, and suffered a permanent brain injury.

The Facts:

Surgery was scheduled due to nasal obstruction and chronic sinusitis (sinus infections). It took place at a local hospital. The surgery itself took 51 minutes. Following surgery, the patient was placed in the recovery room for roughly two hours and then moved to the outpatient discharge area.

Prior to discharge, it is documented that the patient’s blood pressure was 266/78. It is also documented that the patient was given medication because of “headache” complaints. Yet, despite the documented blood pressure of 266/78 and complaints of a headache, the hospital staff chose to discharge the patient home.

Shortly after arriving home, the patient experienced paralysis. As a result, he was unable to move from his couch or get to a telephone. He was essentially stuck there until the next morning when he was found by a friend who came to visit. An ambulance was called and he was taken to the ER where a CT scan showed a pneumocephalus (the presence of air or gas within the cranial cavity) with posterior displacement of bilateral frontal lobes. The patient was then transferred to a tertiary care hospital where he was admitted.

There, the patient was given IV antibiotics, had serial CT scans of the brain, and another corrective endoscopy performed by the ENT. According to the initial CTs performed early after the incident, the patient was noted to have bilateral frontal lobe mass effect with posterior displacement. According to a pathologist report, a specimen collected from the right ethmoid sinus described “nerve profiles” noted in the specimen that should not be there. The pathologist also noted that the possibility of dura mater (the outermost and most fibrous of the three membranes covering the brain and the spinal cord) could not be excluded.

Tragically, in the end, the patient suffered cognitive brain damage, permanent memory loss, a decreased IQ, weakness in the lower extremities, mild seizures, etc. Making the injury even worse, this patient, a veteran, was still working, had an extremely high tested IQ, and was very social. Following this injury, he was unable to work and needed help with basic activities of daily living.

We brought suit against the ENT and the hospital (based on nursing negligence). In the ENT’s deposition, he took the position that although he was in charge of the patient’s discharge, he was never told by the nursing staff – in the discharge report given over the telephone - that the patient had a blood pressure of 266/78 or a headache. He also testified that if he had been notified, he would have known that it was an emergency situation and needed to be treated immediately.

In the nurse’s deposition, she agreed that she had a duty to notify the ENT of a blood pressure of 266/78. To defend herself, she then claimed that the documented blood pressure of 226/78 must have been a mistake. She then had to take the position that this mistake was completely coincidental to the patient also having a headache and later found with paralysis and a brain injury.

As is typical in all malpractice cases, the insurance defense lawyers also tried to blame the patient for his injuries. Here, the insurance lawyers asserted that our client’s brain injury was a complete product of his history of drinking alcohol, and unrelated to the malpractice and documented brain injury from that malpractice.

Prior to trial, the case settled for a substantial amount.