Child left with permanent ear damage after growth not diagnosed, inquiry hears

A young child whose chronic ear condition went undiagnosed despite several examinations has been left with permanent damage and faces years of treatment, a Medical Council inquiry has heard.

The child developed a cholesteatoma – a rare growth that can lead to hearing loss and other problems – but it was not immediately identified despite seeing a specialist several times when he was between two and four years old.

The fitness to practise hearing on Tuesday heard the boy, now eight years old, will remain in the care of doctors throughout his childhood and into adulthood.

“It will be an ongoing difficult and uncomfortable future,” barrister Neasa Bird, acting for the Medical Council, told the hearing which was attended by the boy’s parents.

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Consultant otolaryngologist Dr Ibrahim El-Sherif, who had attended to the youngster at St Francis Private Hospital in Mullingar, Co Westmeath and Our Lady of Lourdes Hospital, Drogheda, Co Louth, admitted to poor professional performance in respect of four allegations.

These were that on two dates in December, 2014 and February, 2015, he failed, in a timely manner or at all, to diagnose the cholesteatoma and that he failed to treat it appropriately.

He also admitted failing in a timely manner to communicate a diagnosis from a histology report in September, 2013 that suggested a cholesteatoma, to his GP.

Finally, he accepted that in April, 2014 he discharged the child from specialist ear, nose and throat follow-up care in circumstances where he ought to have known it was inappropriate to do so. Several other allegations were withdrawn by the Medical Council.

A cholesteatoma is a destructive condition in which skin grows in layers in the middle ear and which, if untreated, can erode bone and cause permanent damage and problems with balance. Ultimately, it requires surgery.

The child had been experiencing left ear infections and related difficulties from a young age, the inquiry was told. He was taken to see Dr El-Sherif who removed an ear growth and initially told him he would have a “long road ahead” in terms of treatment but later discharged him from his care, a decision that had surprised his parents.

When he later began to experience recurring difficulties, they had to seek a referral to go back to see him again. Several further examinations failed to accurately diagnose the severity of the problem.

The child was eventually referred for alternative specialist care which in August, 2015 diagnosed the presence of a cholesteatoma. This was subsequently removed.

Hearing loss

Ms Bird explained that by this point the child had suffered hearing loss and very extensive erosion of the ear. Today, she said, he remains in medical care and underwent further surgery last February.

Speaking on behalf of the boy’s parents, she said he had been “through an awful lot as a baby and a child” and there should have been no delay in his treatment.

The inquiry was told he will require care for the remainder of his childhood and will later have to attend an adult hospital.

He currently suffers from both vertigo and tinnitus and, because he cannot get his ear wet, is unable to swim. He also has a permanent hole in his ear drum, Ms Bird explained.

Dr El-Sherif's barrister Cathal Murphy said the child's condition was very rare and difficult to diagnose, affecting just three in 100,000 children a year in that age group.

He also said there was no case the delay had led to a recurrence of the condition and that surgery would have been inevitable.

At five months, Mr Murphy argued, it was "a relatively short delay" in having his case referred for appropriate treatment. The inquiry heard this was the only complaint Dr El-Sherif, a graduate of Cairo University in 1980, had received during his career.