American Board of Internal Medicine (ABIM) Certification Practice Exam

Which approach is advocated for managing discomfort from cerumen impaction?

1. Always irrigate

2. Observation unless symptomatic

3. Immediate referral to ENT

4. Use of topical steroids

The correct answer is: Observation unless symptomatic

The recommended approach for managing discomfort from cerumen impaction is to observe unless the patient is symptomatic. This management strategy takes into consideration the fact that cerumen, or earwax, typically does not require intervention unless it is causing significant issues. Many individuals with cerumen impaction do not experience symptoms and may not need any treatment at all. By opting for observation, healthcare providers can avoid unnecessary procedures, such as irrigation, which can sometimes exacerbate discomfort or lead to complications, such as perforation of the tympanic membrane or infection. If the patient does develop symptoms, such as ear pain, hearing loss, or signs of infection, appropriate interventions can then be considered. The other management strategies do not align with this conservative approach. For example, immediately referring patients to ENT without a clear indication can be excessive, as many cases can be handled in a primary care setting. Similarly, although irrigation may be appropriate in some cases, it is not universally recommended for all patients and should be approached with caution. The use of topical steroids is not a standard treatment for cerumen impaction and does not address the underlying issue of wax buildup. Overall, observing patients unless they exhibit symptoms allows for a more measured and appropriate approach to managing cerumen impaction,