Ear Wax Removal via Microsuction Consent Form

Procedure Explanation:

Microsuction is a method of earwax removal using a gentle suction device to extract wax and debris from the ear canal. This procedure is performed under direct visualisation with a microscope. It is generally safe and effective but, like any medical procedure, carries some risks.

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

• Infection or inflammation of the ear canal

• Perforation of the eardrum (rare, but possible)

• Temporary dizziness or imbalance

Consent

I have been provided with information about the procedure, its risks. I understand that before the procedure I can ask questions. I hereby consent to undergo the micro-suction wax removal procedure and understand that results may vary. I

acknowledge that no guarantees have been made regarding the outcomes of the procedure.