Definition

What Is Surfer's Ear Or Exostosis of the Ear?

Exostosis is a non-cancerous or benign growth of new bone over existing bone. Surfer's ear is exostosis of the ear canal.

A broad-based bone lesion grows from the temporal bone and projects into the external auditory canal.

Your temporal bones (the green shaded bone in the picture) are situated at the sides and base of your skull.

Exostosis is also called osteoma and is sometimes referred to as a bone spur.

There are many types of exostosis that may occur on a wide-range of bones in the human body including:

  • Footballer’s ankle (lesion on the ankle bone)
  • Buccal exostosis (lesion on the lower jaw or upper jaw)
  • Hereditary multiple exostoses (multiple bone lesions)
  • Subungual exostosis (lesion on the tip of the toe or finger)
  • Torus mandibularis (lesion on the lower jaw)
  • Torus palatinus (lesion on the roof of the mouth)
Temporal bone
Temporal Bone
Causes

What Causes Surfer’s Ear?

Repeated exposure of your ear canal to cold water and wind can cause surfer’s ear.

It’s the evaporative cooling of the ear canal that stimulates bone growth. Excessive bone growth can start to block your ear canal, changing the way sound travels to the eardrum, and increases the risk of infection due to water and debris getting trapped behind the bony lumps.

Some surfers have large exostoses on one side, and small or none on the other. Presumably, this is because of the prevailing wind direction at their local beaches. Some people are also more inclined to develop surfer’s ear and it’s thought this could be due to genetic reasons.

Surfing is not the only activity that is associated with exostosis of the ear canal. Swimming, diving, jet skiing and even driving a convertible can cause abnormal bone growths in the ear from repeated exposure to wind, water and evaporative cooling.

anatomical diagram of surfer's ear
Similarities

Is Surfers Ear the Same as Swimmers Ear?

Surfer’s ear is not the same as swimmer’s ear. Exostoses or the bony growth inside your ear canal are not caused by an infection, but swimmer's ear is.

However, they are commonly associated as surfer’s ear carries the risk of ear infection of the outer ear canal or otitis externa.

If you have surfers ear the water trapped inside your ear canal can cause an infection. This infection is commonly referred to as swimmer’s ear. You may initially present with symptoms of swimmer’s ear if water is trapped inside your ear because of surfer’s ear.

Symptoms

Surfer’s Ear Symptoms

You may have surfer's ear and be completely symptom free.

Patients will typically present with a secondary complaint such as ear pain, hearing loss, or a sensation of fullness (occlusion).

Early symptoms of surfer’s ear include water or debris becoming trapped in the ear more frequently and it also becomes harder to get the water or debris out. If the water or debris remains trapped for long enough, this increases the risk of ear infections.

If your ear canal narrows further with the continued growth of the exostoses, infections can take longer to settle and become more frequent.

Even greater narrowing of the ear canal due to growth of the exostoses will eventually result in conductive hearing loss. Complete closure of the ear canal may require surgery, whereby the bony growth is drilled or chiseled out by an Ear Nose and Throat Surgeon.

surfing duck diving a wave
Pain

Is Surfer's Ear Painful?

Surfer's ear is usually not painful. However, earache caused by repeated ear infections can be very painful.

Pain is more often a secondary result of an ear infection incited by external auditory exostoses.

Diagnosis and treatment

Diagnosing and Treating Surfer’s Ear

Surfer's ear is identified using an otoscope or microscope to view the bony growths protruding under the skin of your ear canal.

Your history is very important in making a diagnosis of this disease. You must have many years of repetitive exposure to cold water and wind, often through water activities such as surfing, swimming or kayaking.

Using a microscope like the one commonly used in Microsuction, surfer’s ear can be identified by your ear nurse. If the condition is causing pain, conductive hearing loss, or repeated ear infections you may be referred to an ENT surgeon for treatment.

ENT surgeons (otorhinolaryngologist) who specialise in diseases that affect the ears, nose and throat call surfers ear, exostosis of the external auditory canal.

The only way to treat exostosis of the external auditory canal definitively is to surgically remove the bony growths. The procedure is often performed through the ear canal using very small chisels.

Operating on surfer’s ear is among the most challenging surgeries that an Ear Nose and Throat Surgeon can perform.

For the patient it can be challenging too, as the mere thought of someone chiseling bone in your ear canal is pretty terrifying. 

Exostoses in the ear canal, as seen through otoscopy
Exostoses in the ear canal
Prevention

How to Prevent Surfer’s Ear

As they say, prevention is better than cure, especially when the cure can mean someone drilling out your ear canal.

The best prevention is to protect your ears from cold water and wind when you can. Earplugs, a wetsuit hoody, earmuffs, or a hat that helps shield your ears will ikely help.

Specialised swimmers or surfers earplugs that may be custom fit, work well for those who frequent, cold, wet and windy environments.

What do I do if I suspect I have surfer's ear?

Hover here to find out!

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