Surfers ear (exostosis of the external ear canal)

Surfers ear (exostosis of the external ear canal)

Surfers ear is an ear condition where abnormal bone growth occurs in the ear canal. These abnormal bone growths are referred to as exostosis. This condition is commonly seen in surfers, explaining the name. In fact it is also seen in other patients with a long-term history of exposure to cold water and wind. This includes sailing, windsurfing, canoeing etc.

Surfers ear may require surgery
Surfers ear may require surgery.

In South Africa it is more commonly seen in surfers from the West coast and Atlantic Ocean, although it is also possible to get in the warmer Indian Ocean. Patients most commonly present between 30 and 40 years of age.

Surfer’s ear affects both ear canals but is usually worse on one side. This depends mainly on the wind direction.

The skin in the ear canal is thin and in direct contact with the underlying bone. Due to the irritation of the cold water and wind exposure the bone in the ear canal form new bone. It is a progressive disorder. This new bone causes narrowing of the ear canal. When the ear canal becomes narrow recurrent infection, wax accumulation and in rare cases hearing loss, may develop. The narrow ear canal may also pose a problem for fitting a hearing aid. In the majority of cases patients may not have any symptoms.

On examination the bony lumps can usually be seen in both the ear canals. It should be distinguished from osteoma, which are round solitary growths in the ear canal. Osteomas are not related to surfing.

Wearing earplugs, swim caps and neoprene hoods reduce the risk of developing surfer’s ear. The risk is 17 times lower if a surfer uses a cap and ear plugs simultaneously.

For symptomatic and complicated cases surgical removal of the bony lumps are indicated. The surgery is not without risk. Exposure after surgical removal may cause recurrence.

Surfers ear exostosis
Surfers ear on the left side. Black asterisks showing exostosis
Normal left ear canal
Normal left ear canal