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What is an Exostosis (A.K.A. Exostoses or Surfer’s Ear)?

Exostosis and Its Impact on Hearing: Causes and Effects

Exostosis is a condition of the external auditory canal that causes an abnormal benign growth of the bone which surrounds the ear canal, typically due to recurrent exposure to cold water (less than 19℃ or 66℉). This thickening begins to narrow the canal or even lead to complete blockage of the canal which results in conductive hearing loss.

Who is most at risk to develop Exostosis?

Exostosis (or exostoses) is commonly referred to as Surfer’s ear. This is because the population of individuals who are most at risk to develop exostoses are surfers and/or swimmers, with about 60%-70% of surfers developing this abnormality over many years of surfing. It usually takes 5-10 years of frequent surfing to cause a significant abnormality in the bone of the ear canal.

The more experienced the surfer/swimmer, the larger and more severe the exostoses. Many professional surfers have had surgery for this condition, similar to how professional runners commonly have lower leg  procedures.

What are the Symptoms of Exostoses?

The symptoms of Exostoses include:

  • Otitis externa (Inflammation and infection of external canal)
  • Frequent wax accumulation
  • Frequent trapping of water after surfing
  • Ear fullness / blocked sensation
  • Hearing loss
  • Ear pain
  • Tinnitus
  • Itching

How is Exostosis diagnosed?

Exostosis can be diagnosed by an experienced ENT, or fellowship trained otologist (ear surgeon). Your ear specialist will first need to take a detailed history, including hobbies and current medications. The otologist will also perform several exams in the clinic, which primarily include microscopic inspection and hearing evaluation. If further inspection is needed, the otologist can also recommend conducting a CT Scan and a comprehensive hearing evaluation (audiogram).

How is Exostosis treated?

Once exostoses are large enough to cause frequent infections, entrapment of debris, or hearing loss, a surgery may be needed. This surgery is called a canalplasty.

There are several surgical techniques used to perform a canalplasty. These include utilizing a chisel, drill, curette, and even a laser. Although the tools utilized for these procedures are different, the surgical process is the same. The surgeon should be experienced enough and comfortable enough with each tool so that the patient can have the best surgical outcome tailored to their specific abnormality.

A trained otologist will work to remove the excess bony formation in an effort to restore the external ear canal to its original shape. Since not all exostoses are created equal, using just one instrument for all exostoses may leave some disease behind. This is why it is imperative that the surgeon have different tools available to remove all sizes and shapes of exostoses.

What should I expect for the surgery?

The surgery for surfer’s ear is an outpatient procedure, meaning you are discharged home on the same day of surgery. The surgery takes about 1-3 hours depending on the severity of the exostoses.

The original surgery for surfer’s ear used to be performed from a postauricular incision, meaning that there was a large incision from behind the ear. Many ear surgeons have enhanced the surgical technique for canalplasty, and it has now become much more minimally invasive. In the hands of a trained otologist, the procedure can usually be performed completely through the ear canal without any external incisions.

There are extreme cases where the surgeon may still want to perform the surgery from behind the ear, but this is usually only if there is complete blockage of the ear canal. It is very important that the patient discuss the surgical approach with their surgeon prior to their procedure day.

After surgery, the surgeon will place a packing inside the ear canal. This feels like an ear plug in the ear. The packing stays for about 1-2 weeks and is removed in the doctor’s office. Surfers typically can go back to surfing about 4 weeks after surgery, as long as they use ear protection.


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