Option B is correct: Live insects cause severe pain and their movement increases harm; they must be killed first by filling the canal with mineral oil or 2-4% lidocaine, then waiting a few minutes until they die, then removing them calmly | A is incorrect: Attempting to grasp a live insect with forceps is very difficult and increases its movement and patient pain | C is incorrect: Irrigation with water may stimulate the insect to move more violently and cause additional harm | D is incorrect: Direct suction may fail with a live moving insect and cause canal trauma | E is incorrect: This is not a surgical emergency; it can be managed in the office after killing the insect | When to request consultation? If removal fails after killing the insect due to fragmentation or multiple deep pieces, or if there is severe bleeding or suspected tympanic membrane perforation | What changes the answer? If the insect is already dead, there is no need to fill the canal with oil, and removal can be done directly with suction or forceps | Consultant Pearl: Never attempt to remove a live insect; fill the canal with oil and have the patient lie on the affected side for 5 minutes, then remove it after death | Sources (EN only): Self-Assessment in Otolaryngology.pdf — p. 142 | Scott Browns Otorhinolaryngology 8th edition volume 1.pdf — p. 557