Clinical observation is the most appropriate management of this patient. Cerumen, or ear wax, is secreted in the lateral third aspect of the external auditory canal and serves as a protective lining against water damage and infection. Cerumen is normally progressively removed from the ear by epithelial migration and movement of the soft tissues of the lateral ear canal by normal motions such as chewing. Cerumen may accumulate if there is excessive production or interference with this normal removal process. Cerumen impaction is an accumulation of cerumen that causes symptoms or blocks visualization of the tympanic membrane. Guidelines suggest that treatment of cerumen impaction is indicated only in symptomatic patients or if the tympanic membrane needs to be visualized. Since this patient's impacted cerumen was found incidentally and he has no hearing loss, tinnitus, or ear pain, clinical observation is all that is needed at this time.

Ceruminolytic agents, manual removal, and irrigation are all effective means to remove cerumen in symptomatic patients. No ceruminolytic agent has been shown to be superior to any other. Manual removal does not subject the ear canal to moisture, so it may be associated with lower rates of infection. However, manual removal requires operator skill and a cooperative patient, with the potential for mechanical injury to the ear canal and tympanic membranes. Vacuum devices that extract cerumen with suction are available and avoid many of the complications of irrigation or manual cerumen removal.