Cerumen Impaction Removal Procedure Note Template Using Alligator Forceps
Mechanical removal using alligator forceps is the preferred technique for cerumen impaction when the tympanic membrane is not intact or when other contraindications to irrigation exist. 1
Pre-Procedure Assessment
Patient Demographics: [Patient name], [Age], [MRN]
Date of Procedure: [Date]
Indication for Procedure:
- Symptomatic cerumen impaction (specify: hearing loss, fullness, pain, tinnitus, vertigo, cough)
- Unable to visualize tympanic membrane for necessary examination
- Interference with audiologic testing
- Hearing aid fitting/maintenance
Modifying Factors Assessment: 1, 2
- History of tympanic membrane perforation
- Previous ear surgery
- Ear canal stenosis/exostoses
- Diabetes mellitus
- Immunocompromised state
- Anticoagulant therapy
Informed Consent
- Risks discussed: discomfort, bleeding, trauma to ear canal, tympanic membrane perforation, infection, vertigo
- Patient verbally consented to procedure
Equipment
- Otoscope with appropriate speculum
- Headlight/light source
- Alligator forceps
- Ear curette (backup)
- Suction equipment (if available)
- Microscope (if available)
Procedure Details
Patient Positioning:
- Patient seated with head tilted slightly toward the contralateral shoulder
- Ear canal straightened by gently pulling pinna upward and backward (adults) or downward and backward (children)
Visualization:
- Otoscope/microscope used to visualize ear canal and cerumen impaction
- Cerumen characteristics: [consistency: soft/hard/impacted], [color], [location], [estimated percentage of canal occlusion]
Cerumen Removal Technique:
- Under direct visualization, alligator forceps introduced into ear canal
- Cerumen grasped with forceps and gently removed in small pieces
- Process repeated until cerumen adequately removed
- [Number of attempts]
- [Estimated amount removed]
Post-Removal Assessment:
- Tympanic membrane visualization: [complete/partial/unable]
- Tympanic membrane appearance: [normal/abnormal - describe if abnormal]
- External auditory canal condition: [normal/erythematous/edematous/abraded]
- Estimated percentage of cerumen removed: [%]
Outcome
- Complete removal achieved
- Partial removal achieved
- Unable to remove - referral to specialist indicated
Post-Procedure Instructions
- Avoid inserting objects into ear canal, including cotton-tipped swabs
- Return if experiencing pain, drainage, hearing loss, or dizziness
- Follow-up recommendations: [specify if needed]
Prevention Recommendations 2
- Avoid cotton-tipped swabs or other objects in ear canal
- Consider monthly application of carbamide peroxide drops followed by gentle irrigation for prevention in recurrent cases
- Consider weekly use of topical emollients to reduce recurrence
Provider Information
- Procedure performed by: [Provider name and credentials]
- Signature: ___________________
- Date: _______________________
Clinical Pearls for Alligator Forceps Use
- Always maintain direct visualization of the forceps tips while in the ear canal
- Use gentle, deliberate movements to avoid trauma to the canal or tympanic membrane
- Remove cerumen in small pieces rather than attempting to extract large portions
- Consider softening hard cerumen with cerumenolytic drops before attempting removal with forceps
- If bleeding occurs or patient experiences significant pain, stop the procedure and consider alternative approaches or referral 1, 3
Remember that manual removal with instrumentation like alligator forceps requires appropriate training and experience to prevent complications. Referral to an otolaryngologist is appropriate for difficult cases or when complications arise 4.