Surfing is a popular recreational activity and competitive sport, with an estimated 37 million surfers worldwide.1 In Australia, this number is estimated at 2.7 million, which accounts for more than one in 10 Australians.2 One of the chronic conditions associated with surfing is exostoses. This condition is a benign and irreversible, broad-based bone outgrowth that can narrow the ear canals, and is commonly referred to as surfer’s ear, although it has also been described in other aquatic sports.

What do exostoses feel like?

Patients can present with a prolonged blocked feeling in the ears following water activities because of water trapping in the ear canal or chronic wax impaction. Patients may also present with recurrent ear infections and pain, or conductive hearing impairment.

How common is it?

The prevalence of this condition in surfers, both professional and recreational, is 38–80% when investigated by otological examination.

Why does it happen?

The precise mechanism for the development of exostoses remains unknown. Cold water and air exposure are believed to stimulate osteoblasts within the temporal bone, leading to bone growth, possibly as a mechanism to protect the tympanic membrane against low temperatures.

It is well known that exostoses is highly correlated with the amount of time spent in the water. The risk increases after five sessions of surfing per month and significantly increases after five years of surfing. Exposure to cold water and wind are recognised risk factors.

How can I prevent them from getting worse?

The regular use of earplugs and avoiding exposure to cold or windy conditions when surfing is recommended.

How are exostoses treated?

The definitive treatment is surgical removal, which is usually only reserved for severe and symptomatic cases. This procedure should only be performed by an Ear, Nose and Throat Surgeon.

When should I see a specialist?

Referral to an otorhinolaryngologist is advised for large lesions, recurrent ear infections or progressive hearing loss. Referral is also recommended if the doctor or patient have any concerns, and when there is suspicion of another diagnosis (e.g. tumour) or when the symptoms are not compatible with clinical findings (eg: hearing loss with only a small lesion). An audiogram may be requested at or before your consultation.

Reference; Australian Family Physician ‘Ear discomfort in a competitive surfer’ Volume 45, No.9, September 2016 Pages 644-646