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Gender--- Male Female
Left Ear* --- Normal Ear Wax Otitis Externa Foreign Body Other What is the Brighton Grade?
--- Grade I Grade II Grade III Grade IV Pope Wick in-situ? --- Yes No Please ensure a follow-up appointment is arranged to remove the Pope Wick Is there an associated ear infection?--- Infection Present No Infection --- Yes No
Right Ear* --- Normal Ear Wax Otitis Externa Foreign Body Other What is the Brighton Grade?
--- Grade I Grade II Grade III Grade IV Pope Wick in-situ? --- Yes No Please ensure a follow-up appointment is arranged to remove the Pope Wick Is there an associated ear infection?--- Infection Present No Infection --- Yes No
