Scary Cases in Otolaryngology

First Edition

Michael P. Platt, Kenneth M. Grundfast

Details: 256 pages, Full Color, Softcover, 7" x 10"

ISBN13: 978-1-59756-654-4

© 2017 | Available


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A good book for Morbidity and Mortality (M&M) conferences!

Scary Cases in Otolaryngology follows a case-based approach that focuses on potential pitfalls, decision analysis, mistakes, and "near misses" in the management of patients with head and neck disorders. This is an invaluable resource for otolaryngologists as it presents difficult cases and builds a discussion around clinical management, prevention, and the legal and ethical aspects of those cases. Current and future professionals in otolaryngology can analyze their own methodologies as well as the work of their peers to continually promote a safer and healthier environment for their patients.

Scary Cases in Otolaryngology is an extension of the annual Scary Cases Conference held by the Boston University School of Medicine. The conference began in 2011 and aims to improve patient safety by addressing complex and controversial cases that involve increased risk, complications, and unfavorable outcomes. The cases in the text have been selected from previous conference presentations.

This exciting and unique book addresses questions such as

  • Did you make a wrong diagnosis before arriving at the correct one?
  • Do you believe that you did everything correctly and the outcome was still unsatisfactory?
  • Did a patient have a serious condition that was difficult to diagnose?
  • Were there major complications?
  • Did you have a difficult ethical dilemma?
  • Were you required to treat a condition beyond your expertise?

This innovative text includes clinical information on cases provided by faculty from top medical schools along with their narratives on what they learned. Contributors also include experts in medical malpractice and malpractice liability insurance. Practicing otolaryngologists, otolaryngology residents, malpractice attorneys, law students, otolaryngology nurse practitioners and primary care physicians will benefit from the examples in these "scary cases."

From the Foreword

I have taught law at Boston University School of Medicine for 4 decades (I also teach health law at the Law School). There is much to know about the law, but for physicians generally, and surgeons in particular, there are two fundamental legal principles that can make their professional lives less stressful, and that can be easily summarized: Act consistent with the medical standard of care (what a reasonably prudent physician would do in the same or similar circumstances), with your patient's informed consent (including disclosure of the risks and alternatives—and their risks). And, in an emergency, treat first and ask legal questions later. The stories in this volume are written by surgeons who understand the importance of living up to the profession's "standard of care," and of obtaining the patient's informed consent before performing surgery. These stories also illustrate how much surgery--and health care in general--has evolved to take informed consent seriously, and to move, slowly but surely, beyond a "culture of silence" to a culture of safety. As scary as most of them are, I found the stories in this book strangely comforting. This is because, I think, they expose and reflect a practice of surgery, at least of otolaryngology, that is patient-centered and populated by surgeons who take both the standard of care and the patient's informed consent seriously.
George J. Annas, JD, MPH, Warren Distinguished Professor and Director, Center for Health Law, Ethics & Human Rights, Boston University School of Public Health


"When I was first presented with the Halloweenlike graphic that is displayed on the cover of this 230-page book, I wondered what scary stories may lie ahead. To my delight, by the time I'd turned over the first few pages, I was totally hooked. I became transfixed and engrossed in each vignette; the pitfalls encountered in the case, the medico-legal consequences of challenging decision making, and unanticipated major complications from ordinary events. These stories ranged across a whole spectrum of ENT practice. As an otolaryngology trainee, I've always been keen to recognise and learn from precarious situations in the hope that it paves the way to adulthood as a consultant. So I am always grateful to learn pearls of wisdom from other colleagues.

This book was written following the success of the 'Scary Cases Conference' which has been held at Boston University School of Medicine since 2011. The merits of this book are largely attributed to the many brave clinicians that give first-hand accounts of how they managed their own 'scary cases'. Various scenarios are covered over 28 case-based discussions including typical areas of controversy such as: how to manage intractable Menière's disease in a patient with only one hearing ear; the consequences that may arise from exposing parapharyngeal fat during a simple tonsillectomy; how to manage a patient that has been seeing you in clinic for years with 'chronic rhinosinusitis' that you later discover has nasal lymphoma; and how to prevent yourself from being seduced into performing a tracheostomy by an institutionalised patient with Munchausen's that continually presents to A&E with airway complications. At $99.95, the book may be a little on the expensive side, but the tips and wisdom imparted throughout the book, highly outweigh its cost. A truly rare and formidable text, for which I would give 5/5!"
Hala Kanona, ST6 ENT, Northwick Park Hospital, London Deanery, UK, in ENT & Audiology News, VOL 26, NO 5 (November/December 2017)

Foreword: What We Learn From the Imperfect
George J. Annas

Preface: What Is a Scary Case?
Kenneth M. Grundfast



Section 1. Airway

Chapter 1. Anesthesia Foreign Body: It's Not Over Until It's Over
Daryl Colden and Christopher Jayne

Chapter 2. Airway Foreign Body: Simulation in Action
Gi Soo Lee and David W. Roberson

Chapter 3. Tracheostomy: An Unusual Indication
Edward J. Reardon

Chapter 4. Airway Fire: Why Are They Called "Laser-Resistant" Tubes?
Timothy D. Anderson

Section 2. Risk Management

Chapter 5. The Uninsured Patient: Maintaining the Standard of Care
Wendy B.R. Stern

Chapter 6. Facial Plastic Surgery: The Case Without End
Jeffrey H. Spiegel

Chapter 7. Malingering: An Unusual Stapedectomy Outcome
Terry J. Garfinkle

Chapter 8. Four Things to Keep in Mind to Make Those Scary Cases a Little Less Formidable
Anthony E. Abeln

Chapter 9. Malpractice Defense From the Expert Witness Perspective
R. William Mason

Section 3. Medical Ethics

Chapter 10. Decision-Making Capacity: You Don't Want to Have Surgery, But You Have to Have Surgery
Kevin S. Emerick

Chapter 11. Facial Excision: Maintaining Control in the Face of Cancer
Daniel G. Deschler

Chapter 12. Unrelenting Meniere's Disease: Ear Surgery in an Only Hearing Ear
Daniel J. Lee and Samuel R. Barber

Chapter 13. Unexpected Lymphoma: The Routine Scary Case
Jerry M. Schreibstein

Chapter 14. Tracheotomy: A Scary Chief Complaint
Bruce R. Gordon

Section 4. Neural Injury

Chapter 15. Orbital Hematoma: In the Public Eye
Ralph Metson and Christopher David Brook

Chapter 16. Facial Nerve Injury: The Service Recovery Paradox
Kimberly A. Russell and Robert W. Dolan

Chapter 17. Encephalocele: An Unexpected Finding
Jonathon Sillman

Chapter 18. Intracranial Extension: A Benign Disease?
Scharukh Jalisi, Avner Aliphas, Samuel J. Rubin, and Kenneth M. Grundfast

Chapter 19. Skull Base Injury: A Scary Harpoon
Ameer T. Shah and Walid I. Dagher

Chapter 20. Brain Herniation: A Delayed Complication
Scharukh Jalisi, Samuel J. Rubin, and Kevin Wu

Section 5. Vascular Injuries

Chapter 21. Aberrant Carotid: A Bloody Myringotomy
Yehia Mohammed Ashry and Dennis S. Poe

Chapter 22. Radiation Therapy for Laryngeal Cancer: "Organ Preservation"
Jonathan C. Simmonds and Elie Rebeiz

Chapter 23. Helicopter Flight: A Scary Post-Tonsillectomy Bleed
Edward F. Caldwell and Hani Ibrahim

Chapter 24. Sentinel Bleed: The Saturday Night Bleeder
Barry J. Benjamin and Namita R. Murthy

Section 6. Professionalism

Chapter 25. It Was Not Your Fault!
Charles W. Vaughan

Chapter 26. Tunnel Vision: Too Little... Too Late...
Scott Finlay and Mark S. Volk

Chapter 27. Chronic Traumatic Encephalopathy: Who Wants to Fight?
Michael P. Platt and Robert A. Stern

Chapter 28. Helping Your Colleague: No Good Deed Goes Unpunished
Aaron R. Dezube, Christopher W. Tsang, and Mark Vecchiotti

Michael P. Platt

Michael P. Platt, MD, MSc, FAAOA is Associate Professor and Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the Boston University School of Medicine. He grew up in northeastern Pennsylvania and attended the University of Scranton, receiving a BS degree in Biology 1994. After receiving an MD degree from Jefferson Medical College in 2002, he did a residency in otolaryngology-head and neck surgery at Albany Medical Center from 2002 to 2007. Subsequently, he went on to pursue a one-year fellowship in endoscopic sinus surgery at the Massachusetts Eye and Ear Infirmary. He joined the faculty of the Department of Otolaryngology-Head and Neck Surgery at Boston University School of Medicine in 2008. During his tenure at Boston University, Dr. Platt completed a master's degree in Clinical Bioinformatics in 2014, served as Quality and Safety Officer for the department from 2013 to 2015, and became Residency Program Director in 2016. Dr. Platt is the author or coauthor of 42 scientific reports and book chapters. He has been elected to the Board of the American Academy of Otolaryngic Allergy and sits on the Editorial Board of the International Forum of Allergy and Rhinology. Dr. Platt has an interest in research relating chronic sinusitis to allergic disease, novel methods for residency education, and risk management education through Scary Cases conferences.

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Kenneth M. Grundfast

After completing his residency in otolaryngology in 1977 at what was then known as the Boston University-Tufts University Combined Otolaryngology Residency Program, Kenneth M. Grundfast, MD, FACS, FAAP went to the Children's Hospital of Pittsburgh for a one-year fellowship in pediatric otolaryngology, and upon completion of the fellowship, he joined the faculty of the University of Pittsburgh School of Medicine with a clinical appointment in the Otolaryngology Department at the Children's Hospital of Pittsburgh. In 1980, he became Chair of the Department of Otolaryngology at the Children's National Medical Center in Washington, DC, where he remained until 1996. In the academic year 1989-1990, he took a one-year sabbatical to pursue research on hereditary deafness at the National Institute on Deafness and Communication Disorders. In 1999, Dr. Grundfast returned to Boston be accept the position that he still holds as Chair of the Department of Otolaryngology at the Boston University School of Medicine and Chief of Otolaryngology at the Boston Medical Center (BMC). Dr. Grundfast has held leadership positions, including holding the office of president of the Metropolitan Washington DC ENT Society; the American Society of Pediatric Otolaryngology; the Society for Ear, Nose, Throat Advancements in Children; and the New England Otolaryngology Society. He has also served as vice president of the American Academy of Otolaryngology-Head and Neck Surgery. He has been the recipient of many awards and commendations, including being listed repeatedly for more than 10 years in Boston Magazine as one of Boston's "Best Doctors," and he received from the Society for Ear, Nose, Throat Advancements in Children (SENTAC) first a Lifetime Achievement Award and, more recently, the SENTAC Humanitarian Award. Although Dr. Grundfast spent the first half of his career as a pediatric otolaryngologist, since he became chair of otolaryngology at the Boston Medical Center, his clinical practice has focused on diagnosis and management of ear and hearing disorders in adults and children. Dr. Grundfast has an interest in biomedical ethics, and he served for 10 years as chair of the BMC Ethics Committee.

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