INTRODUCTION: Aircraft maintenance workers may be exposed to organophosphates in hydraulic fluid and engine oil. Previous research has indicated that inhalation may not be the primary exposure route. This study sought to measure dermal contact and inhalation in conjunction with cholinesterase inhibition and determine if Air Force Specialty Code serves as an exposure predictor.METHODS: Aircraft maintenance workers were sampled for changes in acetylcholinesterase and butyrylcholinesterase. Dermal contact was measured using wrist-worn silicone passive dosimeters and inhalation exposure was measured using thermal desorption tube air sampling.RESULTS: Overall prevalence of any cholinesterase inhibition in the study population was 25.33%. Prevalence of inhibition of acetylcholinesterase and butyrylcholinesterase was 18.67% and 6.67%, respectively. The mean tributyl phosphate result was 1.71 ng of tributyl phosphate per gram of wristband (ng g1) [95% confidence interval (CI): 5.63, 9.05]. Triphenyl phosphate was more prevalent, with only one sample below the limit of detection (mean 1386.26 ng g1; 95% CI: 7297.78, 10,070.31), and tricresyl phosphate was found in every sample (mean 4311.65 ng g1; 95% CI: 8890.24, 17,512.31). No organophosphates were detected via air sampling.DISCUSSION: Workers experienced organophosphate exposure and cholinesterase inhibition, but the study was not large enough to establish a statistically significant association between exposure and disease. Exposure to organophosphate esters is more likely to occur through contact and absorption of chemicals through the skin than through inhalation of oil mists. Air Force Specialty Code does not appear to be a good predictor of exposure to organophosphates. Future studies should consider using a larger sample size.Hardos JE, Rubenstein M, Pfahler S, Sleight T. Cholinesterase inhibition and exposure to organophosphate esters in aircraft maintenance workers. Aerosp Med Hum Perform. 2020; 91(9):710714.