Emotional investments in surgical decision making.

Gordon Smyth had a deep emotional investment in closed cavity surgery for cholesteatoma but, nonetheless, later acknowledged that he believed that he had been mistaken. Emotional investments create problems for all surgeons. Sometimes they have difficulty in recognizing that they need to change what they are doing. This is especially important in the management of Ménière's disease where unproven surgical procedures are often perpetuated. Surgery on the endolymphatic sac is of doubtful value but still continues to be the most frequently performed operation for this condition. Surgeons need to reconsider the evidence and question the appropriateness of these operations.