Patient Consent Form - Micro-Suction Wax Removal

 

Procedure Information:
Micro-suction is a safe and commonly used method of removing earwax
and debris from the ear canal. It involves using a small suction device
under direct vision through a microscope. This procedure is typically
quick, effective and well-tolerated. However, as with any medical
procedure, there are potential risks and complications.

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Potential Risks and Complications:
The potential risks and complications of the micro-suction wax removal
procedure may include but are not limited to:
- Minor irritation or discomfort during the procedure
- Temporary hearing loss lasting up to a few hours (1 in 100)
- Temporary dizziness or imbalance (1 in 200)
- Infection or inflammation of the ear canal (1 in 500)
- Perforation of the eardrum (1 in 10,000)

 

Consent Declaration:
I confirm that:
- I have been provided with information about the procedure and its risks.
- I have had the opportunity to ask questions and have received satisfactory answers.
- I understand the potential risks and complications involved.
- I understand that no guarantee can be given about the outcome of the procedure.

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Source: The British Society of Otology