External auditory canal exostoses, also known as surfer's ear, are benign bony overgrowths of the bony external auditory canal brought about by exposure to cold wind and water combined.
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Epidemiology
The estimated prevalence in cold-water surfers is thought to range between 70-80% 5,6,8.
Clinical presentation
Patients may be asymptomatic or present with cerumen impaction, conductive hearing loss and/or otitis externa 8.
Pathology
Exostoses develop from prolonged irritation of the external auditory canal, typically with repeated cold-water exposure, which is thought to stimulate new bone formation at the tympanic ring within the external auditory canal 8. Exostoses have also been reported to occur after warm-water exposure 7.
Radiographic features
CT
broad-based or more focal circumferential bony overgrowth of the osseous external auditory canal
bilateral in many cases
Treatment and prognosis
Wearing ear plugs or hoods while in cold-water can reduce the occurrence and/progression of exostosis 8. Canalplasty may be required in cases where complications (hearing loss, infection) has occured 8.
Differential diagnosis
external auditory canal osteoma: unilateral focal, pedunculated bony overgrowth
external auditory canal cholesteatoma: typically unilateral bony flakes with scalloping of the adjacent bone
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