What is it?

Also known as Surfer’s Ear, exostosis is multiple bony outgrowths of the external auditory canal (or outer ear) that is generally benign. This reactive formation of bone is thought to be secondary to prolonged cold water exposure. The bony outgrowth is progressive and forms over years of exposure most commonly in waters less than 60 degrees Fahrenheit. Coldwater surfers, swimmers and scuba divers are usually affected by this progressive process depending on exposure time.

Symptoms/Risks

For many suffering from EAE, there are no symptoms, and it is often found incidentally during routine evaluation. Others may be symptomatic. Common complaints include recurrent ear infections and wax build up. Some may also experience a plugged sensation, hearing loss, ear pain and tinnitus (ringing sound).

Risk factors include:

• Prolonged exposure to cold water

• Frequent ocean exposure to water less than 60 degrees Fahrenheit

• Lack of appropriate ear protection

Sports Medicine Evaluation & Treatment

Physical examination of the ears may show the ear canal narrowing via bony lesions. These lesions are usually found to be affecting both ears. While it can be worse in one ear, other causes may be considered if the lesion is only on one side or if only a single bony lesion exists. Imaging is not routinely performed, however CAT scans are performed in some cases to determine the extent of the condition.

Medical management is utilized for recurrent ear infections and ear wax impaction in the form of droplet medications. Hearing loss may require further investigation in the form of an audiogram (Hearing Test). If symptoms persist, then a Sports medicine physician may refer to a head and neck specialist for surgical intervention of the bony outgrowth.

Injury Prevention

Individuals can prevent this condition by wearing ear plugs and limiting exposure to cold water less than 60 degrees Fahrenheit.

Return to Play

Athletes may continue with cold-water sports once symptoms improve during medical management. If surgery is performed, then patients may return to water once your physician feels the ear is well healed. A protective silicone ear plug may be used to prevent water from entering the canal up to one week post-operatively. However, these should already be worn for preventive measures.

AMSSM Member Authors
Thomas Stocklin-Enright, DO

References
1) House JW, Wilkinson EP. External auditory exostoses: Evaluation and treatment. Otolaryngology–Head and Neck Surgery (2008) 138, 672-678.
2) Reddy V, Abdelrahman T, Lau A, Flanagan PM. Surfers’ awareness of the preventability of ‘surfer’s ear’ and use of water precautions. Journal of Laryngology and Otology (2011) 125, 551–3.
3) Kroon D, Lawson M, Derkay C, Hoffmann K, McCook J.Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngology - Head Neck Surgery (2002) 126, 499–504.