Informed consent for tonsillectomy: Do parents comprehend the information we provide?

OBJECTIVE: Informed consent is an important part of the surgical process. Based on our clinical experience, we hypothesized that parents providing consent for their children's tonsillectomy do not comprehend all the information that is given to them by the operating surgeon at the time of a conventional consent process. MATERIALS AND METHODS: Parents whose children were scheduled for tonsillectomy with or without adenoidectomy and/or tympanostomy tubes insertion were enrolled. Within one hour after the consent process, they were asked to complete a questionnaire designed to collect demographic data and to evaluate how much of the information that was given to them was actually understood. RESULTS: Ninety-seven parents were enrolled between October 2011 and March 2013. The average percentage of correct answers (score) for the 16 multiple-choice questions was 76.3%. The average scores were 84.8% for the native Hebrew-speaking parents and 71.9% for the parents whose first language was other than Hebrew (p < 0.01). The average scores were 83.3% for the parents who are healthcare system workers and 74.4% for those parents whose profession is not related to medicine (p < 0.05). Fifty parents (51.5%) responded incorrectly to at least one of two questions that we defined as essential: "What would you do if your child starts to bleed from the mouth" and "What kind of food is recommended for your child during the first week after the surgery". CONCLUSION: The current conventional method of obtaining informed consent for tonsillectomy is inadequate, as reflected by the low level of parental comprehension of essential information. Further studies which will evaluate methods for improving the consent process are highly warranted.

[Postcricoid vascular lesion in an infant].

A 7-months-old female presented with coughing spells while feeding. Flexible laryngoscopy revealed a round bluish mass, emanating from the postcricoid area when the child cried or strained and disappeared when she relaxed. She was treated with systemic steroids for a month and was doing well. There was no change in the lesion. On examination at age 18 months the lesion disappeared. In a review of the literature, the authors found 6 articles describing 19 children with postcricoid vascular lesions. Seven children did not have significant related problems and did well without any treatment. Eight cases had significant co-morbidity. Treatment for symptomatic children included systemic or intralesion steroids, laser ablation and open resection. Postcricoid vascular lesion is a rare entity with a typical appearance. The recommended workup includes flexible laryngoscopy and videofluoroscopy. There are several treatment options for symptomatic children.