Exostoses (Surfer’s Ear)

Growth of Exostoses

Exostoses grow in response to cold water or wind stimulation of the ear canal. New bone is created which gradually narrows the ear canal. It usually takes a few decades of growth before the exostoses reach a size large enough to cause symptoms.

Exostoses are particularly common in surfers and swimmers, particularly those who continue during the winter months.

Symptoms

Patients develop symptoms when the exostoses, wax or dry skin occlude the ear canal and water and debris becomes trapped. This can result in ear infections, pain, hearing loss and tinnitus (ringing of the ear). Typically patients are in their 30s or 40s before symptoms become persistent and troubling.

When is surgery necessary?

Once a patient is experiencing persistent symptoms or frequent infections, surgical treatment can be considered. If exostoses are detected during a routine examination, it does not necessarily mean they need surgery. Regular clearing of earwax and debris with the aid of a microscope and suction may be sufficient to control symptoms for some time. Once the exostoses completely occlude the ear canal, cleaning of the canal can become difficult, painful or simply not completely effective.

Ear infections that are not treated can cause persistent pain and hearing loss. The infection can also spread to involve nearby structures. People with diabetes are more susceptible to a spreading ear infection.

How is the surgery performed?

An incision is made behind the ear. Looking through a microscope, the surgeon carefully lifts the ear canal skin off the exostoses. Great care is taken to preserve this healthy skin, as it will be used to line and repair the ear canal once the exostoses have been removed. A high-speed drill is used to carefully remove the bone. A dressing is placed inside the ear canal at the end of the procedure. The operation takes around 3 hours per ear.

Recovery after surgery

One or two weeks off work are usually required after surgery. Patients typically stay in hospital for one night. On discharge from hospital there will be a small pack in the ear canal, which will be removed at the first post-operative visit. There may be some leakage of bloodstained fluid as the ear canal heals. Pain usually settles down after a couple of days. The dressing is removed from the ear canal after one or two weeks, and the ear is checked every fortnight until the skin has healed. This generally takes four to eight weeks. During this period the operated ear needs to be kept dry, and swimming or surfing is not possible. Patients who have a history of many infections or a chronic infection tend to have more delayed healing.