Surfer’s ear (exostoses of the external auditory canal) is a slowly progressive ear condition in which a benign bone growth develops as a result of chronic exposure to cold water and cold wind. This condition is common in surfers, but anyone who may be exposed to cold water and wind on multiple occasions, such as swimmers, divers, kayakers and participants in other maritime activities, may develop this disease. Usually the condition does not cause any symptoms, but occasionally the bony protrusions in the bony part of the ear canal do cause symptoms such as hearing loss, repeated middle ear infections and an ear discharge. Treatment consists of removing debris from the external auditory canal that becomes trapped there by abnormal bone growth, although surgery is occasionally necessary for severe symptoms. The prospects of treated patients are usually good.

• Epidemiology of bony prominences of external auditory canal
• Causes: Chronic exposure to cold water and cold wind
• Symptoms
• Diagnosis and examinations
• Treatment of surfer’s ear
• Prognosis of bone growth in the external auditory canal
• Prevention of ear exostoses

Epidemiology of bony prominences of external auditory canal

The prevalence of the ear condition is 6.3 per 1,000 people. The disease is more common in men than women, probably because men participate in water activities more often than women. Surfer’s ear occurs at any age, but people in their thirties and forties are more commonly affected.

Causes: Chronic exposure to cold water and cold wind

Exostoses (bone protrusions) develop due to prolonged irritation of the external auditory canal with cold wind or cold water (colder than 19°C), usually cold sea water. The bony prominences arise from the bony tympanic ring. Presumably, exposure to cold water or cold wind causes prolonged vasodilation (vascular dilation) leading to new bone formation. The area above the eardrum ring is extremely sensitive due to the very thin layer of skin covering the underlying bone. The earwax cannot be removed due to bone growth, which means that an ear plug (plug filled with earwax) cannot be removed. This blockage of the external auditory canal leads to the symptoms of the ear condition. Other chemical and physical irritants also sometimes cause this ear condition.

Symptoms

Bony prominences in the bony part of the ear canal usually do not cause any symptoms. Due to a build-up of earwax that cannot be removed; However, an ear plug may develop. This causes the external auditory canal to become blocked, leading to conductive hearing loss and a build-up of debris, which in turn results in chronic otitis externa (middle ear infection). Other symptoms include a feeling of fullness in the ear, ear discharge and/or a feeling of water behind the ears. Very rarely, this disease causes pain directly, but ear pain may be a secondary consequence of a middle ear infection.

Diagnosis and examinations

Interview

Taking a history is extremely important in diagnosing this disease. The condition is not limited to surfing and may also occur in any activity with cold, wet, windy conditions such as windsurfing, kayaking, sailing, jet skiing, kite surfing and diving. The patient must have been repeatedly exposed to cold water or cold wind, usually through water activities such as surfing, kayaking, diving or swimming. The colder the water or wind, the more severe the symptoms of the disease can be. Significant bony prominences in the bony portion of the ear canal usually develop after a minimum of five to ten years of exposure to cold water or cold wind.

Physical examination

The doctor examines the ear with an otoscope (internal visual examination of the ear or ears) and usually sees several lump-like growths on the eardrum ring. The firm growth often occurs in both external auditory canals. If the exostoses are large enough, they obscure the view of the eardrum. If hearing loss is present, the doctor will perform additional audiometry (hearing testing).

Diagnostic research

The history and physical examination are usually sufficient to diagnose bony prominences in the bony portion of the ear canal. The severity of exostoses is graded from 1 to 3 based on the percentage of duct blockage. Furthermore, a CT scan of the external auditory canal may be necessary. On the CT scan, the doctor sees the wide ear canal with excessive bone growth. Usually the CT scan is reserved for surgical planning and this imaging test is not necessary for every patient with surfer’s ear.

Differential diagnosis

The differential diagnosis for growths in the external auditory canal consists of:

• an ear plug
• benign ear polyps
• osteomas (benign growths of bone tissue)
• otitis media

Treatment of surfer’s ear

Treatment usually consists of regular cleaning of the external ear canal to remove trapped debris. If symptoms are severe despite medical treatment (usually more than 80% blockage), surgical intervention under general anesthesia is required. This has improved the quality of life in approximately seven out of ten patients. Surgical complications include tympanic membrane rupture, delayed healing, canal stenosis, loss of high-frequency hearing, temporomandibular joint disorders (jaw and facial pain), and facial nerve palsy. Due to the rate of complications, surgery is reserved for patients with symptoms. If symptomatic exostoses are present on both sides, two operations are performed six weeks apart.

Prognosis of bone growth in the external auditory canal

The condition is progressive, meaning that symptoms worsen over time as exposure to the adverse conditions continues. Eventually, the exotics grow to the point where they become medically problematic. The outcomes in most patients operated on are good, but the rates of surgical complications to alleviate the condition are high.

Prevention of ear exostoses

To prevent the risk of developing surfer’s ear, people should use silicone earplugs; a swimming cap, a diving helmet, a wetsuit hood or other ear protection.

read more

• Swimmer’s ear: Ear condition with discharge from ear & earache
• Otitis media (middle ear infection): Infection in children
• Earache: Pain in the ear due to a problem in the ears or body
• Ear plug: Remove excess earwax, including with water
• Ear Infections: Types, Symptoms and Treatment