Surfer's Ear
Steve Burdine
Jason J. Stacy
Basics-
Surfer's ear, or external auditory exostosis, is a benign overgrowth of the temporal bone in the external auditory meatus that occurs after prolonged exposure to cold water.
-
Patients are usually asymptomatic but may present with recurrent ear infections, conductive hearing loss, and/or pain.
Description
-
Benign overgrowth of temporal bone into external auditory meatus
-
Usually bilateral
-
May have multiple exostoses in a canal
-
Broad-based
-
Occurs after prolonged exposure to cold water
Epidemiology
Rates are highly correlated with time spent in the associated activities. Typically, condition becomes symptomatic after 5–7 yrs of surfing or other cold water activities (1,2).
Prevalence
Prevalence increases with time spent in the associated activities. Surfers have higher rates of exostoses with increasing years of surfing experience.
Risk Factors
-
Occurs after prolonged and/or repetitive exposure to cold water (2)
-
Most common in surfing; also seen in kayaking, white water rafting, diving (breath holding and SCUBA), etc. (3)
General Prevention
-
Best method of prevention is molded earplugs worn during activity.
-
Special headbands that cover ears are also preventive.
-
Ear plugs and headbands may be used in combination.
Etiology
Increasing size of exostoses can lead to recurrent infections, conductive hearing loss, and/or pain.
Commonly Associated Conditions
-
Otitis externa
-
Furunculosis
-
Acute cellulitis
-
Rare: Perichondritis, chondritis, bullous myringitis
DiagnosisVisual diagnosis during otoscopic exam
History
Key points:
-
Amount of cold water exposure
-
Use of preventive aids
-
Previous surgeries
-
Presence of recurrent infections or progressive hearing loss
Differential Diagnosis
-
Fibrous dysplasia
-
Otitis externa
-
Acute otitis media
-
Cholesteatoma
-
Osteoma
-
Mastoiditis
-
Referred pain
-
Temporomandibular joint syndrome
P.567
TreatmentMedication
Medications typically are not needed, unless to treat related bacterial infection or cerumen impaction.
Additional Treatment
Referral
Referral to ENT indicated for recurrent infections, pain, or hearing loss (4)
Surgery/Other Procedures
-
Surgery is definitive care for exostoses.
-
Reserved for severe, symptomatic cases; presence of exostoses without symptoms would not necessitate surgical intervention.
-
Several approaches are used; postauricular is the most common and seems to minimize complications (5).
-
If hearing loss is present, generally there is a good response to surgery with restored hearing.
-
Some patients require repeated surgeries if cold water exposure continues (usually after ≥5 yrs of additional exposure).
Ongoing CarePrognosis
Correctable with surgery but may recur with continued exposure
References
1. Chaplin JM, Stewart IA. The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol Allied Sci. 1998;23:326–330.
2. Kroon DF, Lawson ML, Derkay CS, et al. Surfer's ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngol Head Neck Surg. 2002;126:499–504.
3. Sheard PW, Doherty M. Prevalence and severity of external auditory exostoses in breath-hold divers. J Laryngol Otol. 2008;122:1–6.
4. Mlynski R, Radeloff A, Brunner K, et al. [Exostoses of the external auditory canal: Is the cold water hypothesis valid for patients in continental areas?] HNO. 2007.
5. House JW, Wilkinson EP. External auditory exostoses: evaluation and treatment. Otolaryngol Head Neck Surg. 2008;138:672–678.
Additional Reading
Cooper A, Tong R, Neil R, et al. External auditory canal exostoses in white water kayakers. Br J Sports Med. 2008.
CodesICD9
380.81 Exostosis of external ear canal
Clinical Pearls
-
Benign bony overgrowth of the temporal bone into the external auditory meatus
-
Causes repeated ear infections, hearing loss, or pain in surfers (or other cold water athletes)
-
Preventable with earplugs and/or headbands
-
Surgery is definitive treatment.