External auditory exostosis (Exostoses)

typically firm, sessile, multinodular bony masses which arise from the tympanic ring of the bony portion of the external auditory canal. These growths develop subsequent to prolonged irritation of the canal.
Chronic condition associated with surfing, Diving, Kayaking, Sailing, Swimming
Benign, irreversible
Outgrowth from temporal bone, projects into external auditory canal -EAC
Typical bilateral
Usually asymptomatic – often diagnosed when advanced
Exact mechanism unknown – cold water and air exposure, possibly to protect TM
Correlated amount of time in water, no genetic influence

Clinical

Feeling of fullness in the ears/Prolonged blocked feeling in ears following water activities
Fluid drainage from the ear (otorrhea)
Conductive hearing loss
Water trapping in EAC or cerumen impaction
Recurrent otitis externa
Otalgia

differential diagnoses of EAE include

EAE can be classified into four grades of severity based on the percentage of obstruction of the EAC, as assessed by otoscopy

Ear Protection:
- Ear Plugs: Use ear plugs specifically designed for water sports to prevent cold water from entering the ear canal.
- Hoods and Caps: Wearing a neoprene hood or cap can help protect the ears from cold water and wind.
Limiting Exposure:
- Reduce the frequency of exposure to cold water, particularly in adverse weather conditions.

When exostoses cause significant symptoms, surgical intervention may be necessary. The primary surgical treatment for Surfer’s Ear is called Canalplasty.
Canalplasty Procedure
Preoperative Assessment:
- Audiometry: A hearing test to evaluate the degree of hearing loss.
- Imaging: CT scans to assess the extent of bony growth and plan the surgery.
Surgical Technique:
- Incision: A small incision is made in the ear canal.
- Removal of Bony Growths: The exostoses are removed using specialized surgical instruments. This can be done with a chisel or a high-speed drill.
- Preservation of Ear Canal Skin: Care is taken to preserve the delicate skin lining the ear canal.
Postoperative Care:
- Avoiding Water Exposure: Patients are advised to keep the ear dry until fully healed.
- Pain Management: Pain is typically managed with over-the-counter pain relievers.
- Follow-Up Visits: Regular follow-up appointments to monitor healing and ensure no complications arise.

Recurrence: Exostoses can recur if preventive measures are not followed.
Complications: As with any surgery, there are risks such as infection, damage to the ear canal, and hearing changes.

In cases where surgery is not immediately necessary, management may include:
Ear Drops: To manage any associated infections or inflammation.
Regular Monitoring: Periodic evaluations by an ENT specialist to monitor the progression of exostoses.