For cerumen impaction in pilots, what is the recommended management?

• A. Irrigation with warm water
• B. Cerumen lytics or manual debridement
• C. Antibiotic ear drops only
• D. Immediate surgery

Answer: (B)

Managing cerumen impaction centers on safely loosening and removing the wax so the ear canal is clear again. Using cerumenolytics to soften the buildup makes subsequent removal easier and gentler, and if needed, manual debridement with suction or a small curette can finish the job. This combination directly addresses the blockage without risking trauma to the ear structures, which is especially important for pilots facing pressure changes during flight.

Relying on antibiotics alone doesn’t resolve the blockage and won’t restore ear canal patency, while immediate surgery is unnecessary for routine impaction. Irrigation can be attempted, but it is not the primary, single approach and may be less reliable or riskier in certain situations (for example, if the canal is very narrow or perforation is suspected).