An older adult client reports muffled hearing and a feeling of fulness in their ears. Upon otoscopic examination, the nurse observes impacted cerumen What is the most appropriate initial intervention

Impacted cerumen is a common condition in older adults due to decreased epithelial migration and drier earwax consistency, leading to accumulation in the external auditory canal. This buildup can cause symptoms such as muffled hearing, ear fullness, and discomfort. Initial management focuses on safe removal of the obstruction to restore hearing and relieve symptoms. Ear irrigation is a commonly used, noninvasive method when there is no contraindication such as tympanic membrane perforation. A. Referring the client for evaluation by an audiologist is not the initial step when cerumen impaction is clearly identified as the cause of hearing changes. The obstruction should first be removed to determine if symptoms resolve. Referral may be appropriate later if hearing deficits persist after cerumen removal. B. Advising the client to clean the ears with cotton swabs is inappropriate and unsafe. Cotton swabs often push cerumen deeper into the ear canal, worsening impaction and increasing the risk of injury to the canal or tympanic membrane. Patient education should emphasize avoiding insertion of objects into the ear. C. Performing ear irrigation using warm saline solution is an appropriate first-line intervention for cerumen impaction. The warm solution helps soften and dislodge the wax, allowing it to be flushed out gently. Care must be taken to ensure the tympanic membrane is intact and to avoid excessive pressure, which could cause discomfort or injury. D. Prescribing antibiotic therapy is not indicated because cerumen impaction is not an infectious process. Antibiotics are used for bacterial infections such as otitis media or externa, which present with additional signs like pain, fever, or purulent discharge. Treating with antibiotics would be unnecessary and inappropriate in this scenario.