A case of Keratosis Obturans (wax in ear) was dealt by an ENT Surgeon without rupture of Tympanic Membrane of a patient aged 12 years. Later on after 11 days patient developed signs of meningitis. Patient referred to pediatrician for further treatment. Patient consulted another ENT surgeon who opined no rupture of Tympanic Membrane after investigation of MRI, Otoscopy, Tympanogram, and impedance audiometry. DCDRC, Satara observed that meningitis was developed either on 20/02/2007 or 21/02/2007, which has no nexus with the operation carried out on 10/02/2007. SCDRC overruled decision of DCDRC and dismissed the appeal. NCDRC in revision petition approved the decision of SCDRC.

It was alleged that after the procedure, the patient suffered injury to her right eardrum, which was not treated properly by the OP. Only a cotton swab was placed inside the ear and a bandage was affixed. Thereafter, the patient was getting headache and pain in her right ear. Therefore, she approached the OP but he intentionally ignored her.

On the day after the procedure, the cotton swab and bandage were removed, which revealed infection and foul smell. On 20.02.2007, the OP, after examination of the patient, suspected Meningitis and advised the patient to approach a Pediatrician for further treatment.

Accordingly, the patient was taken to Jeevan Jyot Hospital at Satara on 21.02.2007 and was then admitted at Chirayu Hospital on 22.02.2007. The treatment expenses were Rs. 2 lakh.

Question for Consideration:

1. Whether or not the patient developed Meningitis due to wrong treatment or procedure of the OP, ENT Surgeon?
2. Is there a nexus between previous treatment of otitis externa and Meningitis after 11 days of procedure?

Following issues discussed: Issue of Qualification, Standard Medical Protocol, Investigation, Second Opinion, referral of patient.

NCDRC while disposing the case observed that Dr. Prashant Pol, the OP, a qualified ENT specialist, treated the patient with the requisite care and as per the requisite standard of practice. On considering the subsequent investigations, inter alia the MRI, Tympanogram and Audiometry, and examination reports of another ENT surgeon, Dr. Jaywant Thoke, we find that there was no damage to the eardrum.

It was a simple case of right Otitis Externa (infection of external ear), that was aptly dealt with, and an apt reference to a Pediatrician was also made subsequently.

No direct or related nexus between the initial treatment and procedure undertaken by the OP – doctor and the Meningitis after 11 days of the initial treatment and procedure is made out. [Para 8