Exostoses of the external auditory canal

Abstract

Ear canal exostoses are bilateral, usually symmetric multiple bony growths occurring in the medial portion of the external auditory canal. Also known as surfer’s ear, exostosis is thought to be a reactive process from repeated stimulation by cold water and is much more common than external auditory osteoma. Exostoses are usually asymptomatic and discovered on routine otoscopy. Indications for surgical treatment are recurrent otitis externa, hearing loss, otalgia and other conditions in which access medial to the exostoses is required. Surgery is not risk-free and postoperative complications are the most important factor for negative impact on the patient’s health-related quality of life. This review offers an overview of the recent advances in the understanding of this condition, with a special focus on the etiology and physiopathology of this condition, the different surgical procedures and their outcomes, the risk factors for recurrence and the results of preventive measures. Finally, this review suggests the need for the otological surgeon to acquire a great deal of experience before undertaking surgical treatment of exostoses as it is a challenging operation and, besides expertise, demands great patience and extreme care in order to achieve good results.

Keywords: Exostoses; Surfer’s ear; Ear canal; Surgical procedures; Recurrence; Prevention

Core tip: Readers interested in aquatic sports medicine, otological procedures or bone lesions will find in this review a thorough summary of the most relevant aspects of ear canal exostoses, with a special focus on the major advances achieved in the knowledge of its etiology and pathophysiology, prevention and surgical therapy, and the challenges that remain and may guide research in the next few years and beyond, so that complications are minimized and the best outcomes are achieved.