Malpractice in rhinology

The field of rhinology continues to evolve after the introduction of endoscopic sinus surgery in the 1980s. Despite advancements in technology, the close proximity of the sinonasal cavity to critical neurovascular structures allows for the possibility of major complications. Complications that have been cited in malpractice proceedings include anosmia, cerebrospinal fluid leak due to skull base injury and resultant meningitis, intraorbital injury including orbital hematoma, and even death. Due to the significant impact these complications have on patients' lives, rhinology remains the most litigated subspecialty within Otolaryngology, and payments in malpractice cases can be substantial. In addition to surgical complications, proper informed consent remains a critical factor in many litigation cases. The field continues to evolve rapidly with increasing use of technologies such as balloon sinusotomy and with physicians diverting rhinologic procedures to an office-based setting. However, the same overall themes of appropriate physician-patient communication, comprehensive informed consent, and avoiding unnecessary risks should be considered essential. It often takes many years for cases to proceed from initial injury to medicolegal proceedings and eventually to publicly available court records. Consequently, the impact of many of these changing practice patterns on litigation in rhinology is still unknown. In this chapter, we review the evolution of malpractice within rhinology and highlight strategies to mitigate litigation risk in a rhinologic practice.