Surfer's Ear "Exostoses"

Dr H Sillars – subspecialist ear surgeon

160 Gillies Ave, Epsom, Auckland

(ph) 09 9254060.   (fx) 09 6311962  (e) 

 

Surfer’s Ear / Exostosis

Surfer’s ear is the common name given to the formation of bony lumps within the ear canals. These happen most commonly in surfers because it's repeated cold water immersion that stimulates their growth, early on offering few symptoms but as they progress allowing at times prolonged trapping of water and then, generally at a later point, infections. Management is aimed at trying to prevent their progression, treating deteriorations simply where possible but not uncommonly eventually having to consider a surgical remedy.


What causes them to happen?
Within the adult ear canal (which is some 2.5 cm long) the inner two thirds has a surrounding ring of bone with only a very thin layer of overlying skin. Sandwiched beneath the skin and the bone is an even thinner layer of bone membrane called periosteum – the two together are almost a single layer so with very little mechanical or thermal cushioning. When swimming and especially when in cooler water and in particular in people who swim a lot, repeated chilling and subsequent natural warming of the canal sees the periosteum stimulated and bone cells laid down very slowly but progressively. This is a process that evolves over the years and with the growths often enlarging to a significant point before they become symptomatic. In many the initial awareness of a problem is water getting in and then failing to clear as it becomes “caught” in this narrowed space by surface tension – this is why some, after swimming, have to dance and jiggle their head to shake the fluid loose. With more time and further growth and a channel now even narrower, sees trapped fluid, waterlogged skin and now an infection which may be not only very painful but also difficult to treat.


Diagnosis of Exostoses
These should be suspected in anyone who has been surfing for a significant interval (particularly so if they are winter water enthusiasts and/or have been surfing in colder climates). When the ear is examined typically smoothly rounded white swellings are initially seen – as they enlarge and as they are in a contained space they have to grow towards each other compressing even more the space of the canal. In many, and as at an early stage they are often minimally symptomatic, diagnosis is at the point where water gets caught after a day in the surf, a doctor looks in the ear and the obvious reason is found.