Surfer's Ear and External Auditory Canal Exostoses

QJM: An International Journal of Medicine, 2016, 759

doi: 10.1093/qjmed/hcw148 Advance Access Publication Date: 11 August 2016 Clinical picture

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Surfer’s ear and external auditory canal exostoses Downloaded from https://academic.oup.com/qjmed/article/109/11/759/2631754 by guest on 29 September 2021

A 48-year-old, healthy man, who had been a cold-water surfer for 20 years, presented with a 5-year history of a sensation of blockage in his ears while swimming. He denied having otalgia, tinnitus or hearing loss. Otoscopic examination of both ears showed two torose lesions on the walls of the external auditory canal (Figure 1). We diagnosed external auditory canal exostoses, and advised the patient to use ear plugs to prevent further damage. External auditory canal exostoses are the most common be- nign tumors of the external auditory canal, and their pathology is attributed to hyperostosis of the temporal bone.1 These tumors are caused by prolonged and repeated exposure to cold water (particularly below 19C).2 It is known as “surfer’s ears”, because 59.8%–73.5% of surfers have evidence of this condition.2 Professional surfers are more likely to have exostosis compared with amateur surfers. Although such exostoses are usually asymptomatic, they can cause recurrent otitis externa, ear fullness, hearing loss, ear pain, tinnitus, itching, and a sensation of 3 blockage in affected ears on progression. Characteristic otoscopy Figure 1. Otoscopic view of the right ear shows the bony exostoses on the walls findings include multiple, sessile, bony toroses of both the exter- of the external auditory canal. nal auditory canals.1 In particular, bilateral lesions enable the dif- ferential diagnosis of external auditory canal exostoses from exostoses and the years of experience and frequency of surfing.3 other tumors of the external auditory canal, for example cancer Earplugs aid in the prevention of hyperostosis, but surgery is of the external auditory canal, ostosis, nevus cell nevus. Among considered when the symptoms and occlusion are severe.1 cancers of the external auditory canal, squamous cell carcinoma is the most frequent. These cancers typically have symptoms such as ear discharge and ear pain. The tumor is unilateral, hem- Photographs and text from: Y. Hirose, K. Shikino and M. Ikusaka orrhagic, and progressive. Bilateral and multiple lesions are rare. Department of General Medicine, Chiba University Hospital, Nevus cell nevus is a unilateral, sessile, single black torose. Chiba, Japan. email: [email protected] Bilateral or multiple lesions are rare. The average size is about 10 mm, but a giant tumor may protrude from the auricle. Although frequent symptoms are ear fullness or hearing loss, Conflict of interest: None declared. asymptomatic cases are also found. The pathology of ostosis is attributed to ossification of the connective tissue. However, the References accurate pathology is unclear. The tumor is single, unilateral and pedunculated with a smooth surface; multiple and bilateral le- 1. Kutz JW Jr, Fayad JN. Exostosis of the external auditory canal. sions are rare. Gradual progression of the disease is accompanied Ear Nose Throat J 2006; 85:142. by symptoms of ear fullness and hearing loss. 2. Alexander V, Lau A, Beaumont E, Hope A. The effects of surﬁng Severity is classified by the degree of occlusion; less than behavior on the development of external auditory canal exo- one-third of the cases are mild, one-third to two-third are mod- stosis. Eur Arch Otorhinolaryngol 2015; 272:1643–9. erate, and more than two-third are severe. There is a strong cor- 3. John WH, Eric PW. External auditory exostoses: Evaluation and relation between the severity of external auditory canal treatment. Head and Neck Surgery 2008; 138:672–8.

Received: 16 July 2016; Revised (in revised form): 28 July 2016

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