About exostoses
- Exostoses are bony lumps that grow within the external ear canal
- Normal skin covers exostoses
- Exostoses typically take many years to develop and often more than one are found
Growth of exostoses
- Exostoses form slowly when a new thin layer of bone grows in response to stimulation by cold water or cold air
- Growth typically takes many years for exostoses to reach sizes large enough to cause symptoms
- Exostoses are common in people who swim or surf in cool water – therefore exostoses are also called surfers ear
Symtoms
- Symtoms occur when exostoses and ear wax occlude the ear canal – trapping water and debris
- Repeated outer ear infections (otitis externa) may occur resulting in pain and hearing loss
Diagnosis of exostoses
- Exostoses are diagnoses by examination of the ear canal
- Exostoses can become large and block the ear canal
- They usually occur in both ears but may differ in growth rate and size
- Hearing testing will accurately determine the hearing level and show if exostoses are causing hearing problems
- Occasionally imaging may be needed if other problems are suspected
Treatment
- Many people have small exostoses that do not cause symptoms and do not need to be removed
- If exostoses continue to grow then they may lead to recurrent outer ear infections requiring regular ear care and ear cleaning
- When exostoses occlude the ear canal infections may become frequent and ear cleaning may not be effective
- Reasons to surgically remove exostoses include:
- Hearing loss
- Ear pain
- Repeated infections (otitis externa)
- People with diabetes and those with reduced immunity are particularly susceptible to complications and require prompt treatment
Surgery to remove exostoses
- The incision is usually made behind the ear in the hairline
- An operating microscope is used and great care is taken to remove the bony lump with a high speed drill (like a dentist’s drill), whilst preserving the skin of the ear canal
- The ear canal is widened appropriately
- At the conclusion of the procedure dressings are placed in the ear canal
- The operation usually takes 2 to 3 hours
Recovery after surgery
- Recovery from surgery is usually quick
- Most patients stay in hospital overnight before going home
- A medicated pack is placed in the ear canal and is removed at the 2 week post operative visit
- Ear drops are used to help prevent infection and prevent the pack from drying
- One to two weeks off work are typically needed
- Avoid getting water in the ear
- Typically the only medications required are simple painkillers and ear drops
Possible complications
Complications after surgery for exostoses are uncommon but include:
General risks of surgery
- General anaesthesia can cause complications such as blood clots, chest infections or allergic reactions
- Infection is an uncommon risk
- Bleeding; minor bleeding from the ear may occur during the first 24-48 hours after surgery
- Scarring; generally the incision is placed in our behind the hairline and is not seen
Specific risks of exostosis surgery
- Delayed healing
- Hearing loss, disturbance of balance or tinnitus
- Jaw pain
- Numbness around the ear
- Perforation of the ear drum
Outcomes
- An entirely successful outcome cannot be guaranteed, however, surgical removal of exostoses generally provides satisfying results
- Years of exposure to cold water may provoke regrowth of the exostoses requiring revision surgery
If you have questions about exostoses or surfers ear surgery contact your local doctor, who will arrange for you to see an ear nose throat specialist.