Surfer's ear or exostosis

Surfer's ear, also known as external auditory canal exostosis (EACE) or exostosis, is a condition that every water sports enthusiast should be aware of. This condition, characterized by the formation of bony growths in the ear canal, can eventually lead to hearing loss if left untreated. Whether you're a surfer, swimmer, kayaker, or open water enthusiast, understanding surfer's ear is vital for your hearing health. In this article, we'll explore the causes, symptoms, prevention, and treatment of surfer's ear to help you keep riding the waves while safeguarding your hearing.

What is surfer's ear?

Surfer's ear is a condition where the ear canal narrows due to the development of bony growths. These growths, also known as exostosis, are your body's defense mechanism against prolonged exposure to cold water and wind, especially the combination of the two. They form in an attempt to protect the ear drum from temperature fluctuations and chilling winds. The more time you spend in cold water, the higher the risk of developing surfer's ear. Over time, these bony growths can accumulate and obstruct the ear canal, causing potential hearing problems.

Symptoms of surfer's ear

Surfer's ear doesn't manifest immediately, taking as long as 10 to 15 years to show symptoms. The condition may progress without your awareness, making it crucial to recognize the warning signs:

1. Recurrent ear infections

One of the most common and early symptoms of Surfer's Ear is the recurrence of ear infections. The bony growths within the ear canal create a narrow space where water and debris can become trapped. This trapped moisture and debris create an ideal environment for bacterial or fungal infections to flourish. These infections can be painful and challenging to treat. Symptoms may include otitis, ear pain, itching, and discharge from the ear. It's essential to address these infections promptly, as untreated infections can exacerbate the condition and lead to further complications.

2. Water trapped in ear

As surfer's ear progresses, the narrowing of the ear canal makes it increasingly challenging for water to drain out of the ear after water activities. Surfers, swimmers, and kayakers may notice that, even after multiple attempts to shake their head or hop on one foot, water remains trapped in the ear. This trapped water not only feels uncomfortable but also increases the risk of infections.

3. Hearing loss

The gradual formation of bony growths can eventually lead to hearing loss. Initially, this hearing loss may be minor and go unnoticed, but as surfer's ear advances and more of the ear canal becomes obstructed, hearing impairment becomes more pronounced. The hearing loss associated with surfer's ear is typically conductive, which means it results from sound not being able to pass properly through the ear canal to the eardrum. This can impact your ability to hear sounds clearly and can be especially problematic if left untreated.
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Surfer's ear treatment

If you suspect you have surfer's ear, it's important to seek medical attention. A diagnosis typically involves a thorough examination by a healthcare professional. If necessary, you may be referred to an Ear, Nose, and Throat (ENT) specialist. Treatment options vary based on the severity of the condition:

1. Ear drops

In cases where mild ear infections are associated with surfer's ear, healthcare providers may prescribe ear drops as part of the treatment plan. Ear drops are specially formulated medications designed to be administered directly into the ear canal. These drops can help manage the infection by reducing inflammation, alleviating pain, and addressing the underlying bacterial or fungal causes. The use of ear drops can provide relief from the discomfort and symptoms of ear's surfer. It's crucial to follow the prescribed dosage and instructions for using ear drops to ensure their effectiveness.

2. Physical examination

For mild to moderate ear infections associated with surfer's ear, healthcare providers may prescribe antibiotics to combat the infection. Antibiotics are medications that work to eliminate bacterial infections within the ear canal. These medications can be taken orally or administered topically, depending on the severity of the infection. Antibiotics help to prevent the infection from worseningreduce inflammation, and alleviate symptoms such as ear pain and discharge. It's essential to complete the full course of antibiotics as prescribed by your healthcare provider, even if symptoms improve before the medication is finished. This ensures the infection is completely eradicated and reduces the risk of recurrence.

3. Surgery

In severe cases, surgical removal of the bony growths is the only definitive treatment. This operation, often performed by an ENT specialist, involves carefully removing the exostosis to restore proper ear canal function. The surgery is usually performed under general anesthesia, and it takes about 1-2 hours.

There are two main types of surgery for surfer's ear:

  • Endoscopic surgery: This is the most common type of surgery. It is performed through the ear canal using a thin, camera-equipped tube called an endoscope. The surgeon uses a variety of instruments to remove the bony growths.
  • Postauricular surgery: This type of surgery is less common. It is performed through an incision behind the ear. The surgeon removes the bony growths and then repairs the ear canal.

The type of surgery that is best for you will depend on the severity of your condition and the location of the bony growths.

Recovery from surgery

Surgery is usually done as an outpatient procedure, and patients can typically return home the same day. However, the recovery period after surgery is essential, as it takes at least one month for the ear canal to heal.

Risks of surgery

The risks of surgery for surfer's ear are relatively low. However, as with any surgery, there is a risk of infection, ear bleeding, and other complications.

Cost of surgery

The cost of surfer's ear surgery in Australia typically exceeds $2900.

4. Preventive measures

After treatment, it's essential to continue preventive measures such as wearing earplugs to avoid the reoccurrence of surfer's ear.

What does surfer's ear feel like?


Surfer's ear can make you feel like your ear is plugged and itchy inside. As those bony growths in your ear canal narrow it, it becomes tougher to get water out after a swim or surf. A key sign is having ear infections happen more often. Water gets trapped, and it's hard for air to dry things out, so bacteria from the water or debris can lead to those infections.

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Diagnosing surfer's ear

Surfer's ear can be diagnosed by a doctor or audiologist. They will look into your ear canal with a special instrument called an otoscope. They may also order a hearing test to assess your hearing loss. Here's an overview of the diagnostic process for surfer's ear:

1. Medical history

The diagnosis often begins with a discussion of your medical history. Your healthcare provider will ask questions about your water activitiesfrequency of exposure to cold water, and any symptoms you may be experiencing, such as ear infections, water trapped in the ear, or hearing loss. Providing a detailed and accurate medical history is essential for a comprehensive evaluation.

2. Physical examination

A thorough physical examination of the ear is the next step in the diagnostic process. Your healthcare provider will use an otoscope, a handheld device with a light source and magnifying lens, to examine the external ear canal and eardrum. During this examination, the healthcare provider will look for the presence of bony growths within the ear canal. Exostoses typically appear as irregular bony protrusions or lumps within the ear canal. The degree of narrowing or blockage will also be assessed during this examination.

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3. Hearing tests

If you are experiencing hearing loss, your healthcare provider may recommend hearing tests to assess the extent of hearing impairment. Hearing tests, also known as audiometry, involve listening to sounds of different pitches and loudness levels to evaluate your ability to hear and understand speech. These tests can help determine whether the hearing loss is related to surfer's ear.

4. Imaging tests

In some cases, imaging tests may be necessary to confirm the diagnosis or assess the extent of the bony growths. Computed tomography (CT) scans are commonly used for this purpose. CT scans provide detailed images of the ear canal and any exostoses present. This imaging can help determine the size, location, and density of the growths, which can be useful in treatment planning.

5. Referral to an ENT Specialist

If the diagnosis remains unclear or if the condition is advanced, your healthcare provider may refer you to an Ear, Nose, and Throat (ENT) specialist, also known as an otolaryngologist. ENT specialists have specialized training in ear and hearing disorders and can provide a more in-depth evaluation and treatment options, including surgical intervention if necessary.

Surfer's ear vs swimmer's ear

Surfer's ear and swimmer's ear are different ear conditions.

  • Surfer's ear, also known as exostosis, results from repeated exposure to cold water and wind. It leads to the growth of bone in the ear canal, which can narrow it, trapping water and increasing the risk of infection. Symptoms include water retention, infections, and potential hearing loss. Surgical removal of excess bone growth is a common treatment, and prevention involves wearing earplugs and protective gear in cold conditions.
  • Swimmer's ear, or otitis externa, is an infection of the outer ear canal. It arises when water remains trapped in the ear after swimming. Warm, moist conditions in the ear canal create an ideal environment for bacterial and fungal growth, resulting in symptoms like redness, pain, and hearing loss. Preventive measures include earplugs, prompt ear drying, and avoiding contact with chemicals that can contribute to the condition.

Recognizing the differences between these conditions is crucial for their timely diagnosis and appropriate treatment. Whether you're a surfer or a swimmer, understanding these distinctions ensures you can continue to enjoy water activities with minimized discomfort and health risks.

Causes of surfer's ear

The primary cause of surfer's ear is prolonged exposure to cold water and cold air, making surfers and water sports enthusiasts particularly susceptible to surfer's ear. Cold water and wind exposure stimulate bone-producing cells in the ear canal, leading to the formation of bony growths.

Surfer's ear prevention

Preventing surfer's ear is crucial, especially for those passionate about water sports. Here are some preventive measures:

1. Wearing swimming ear plugs

The most effective way to prevent surfer's ear is by wearing swimming earplugs while participating in water activities. They create a barrier to keep cold water and wind from reaching the ear canal.

2. Keeping ears dry after water activities

After water-based activities, make sure to thoroughly dry your ears. Tilt your head to each side to help water drain out of the ear canals. You can also use a clean, dry towel to absorb any residual moisture. Keeping your ears dry helps prevent the conditions conducive to infections.

3. Using hood or headband

Wearing a neoprene hood or special headband that covers and seals the ears provides an extra layer of protection against cold water and wind.

4. Using a combination approach

For enhanced protection, consider using both earplugs and a hood or headband together.

5. Regular checkups

If you're a frequent water sports enthusiast, it's a good practice to schedule regular ear checkups to monitor your ear health.

6. Avoid external objects

Avoid using cotton swabs or other objects to clean your ears.

Who is at risk for surfer's ear?

People who are at increased risk for surfer's ear include:

  • Surfers and other water sports enthusiasts
  • People who work or spend a lot of time in cold, windy conditions
  • People with a family history of surfer's ear

Complications of surfer's ear

Surfer's ear can lead to a number of complications, including:

  • Hearing loss: Surfer's ear can cause hearing loss by blocking the ear canal and preventing sound waves from reaching the eardrum.
  • Ear infections: Surfer's ear can make you more susceptible to ear infections.
  • Otitis externa: also known as swimmer's ear, is an inflammation of the outer ear canal. Surfer's ear can make otitis externa more likely to occur.
  • Cholesteatoma: a benign but destructive growth that can form in the middle ear. Surfer's ear can increase the risk of developing cholesteatoma.

If you have surfer's ear, it is important to be aware of these complications and to see a doctor or audiologist regularly to monitor your hearing.

Surfer's ear and cochlear implants

Cochlear implants are electronic devices that can help people who are deaf or severely hard of hearing. Surfer's ear can make it difficult to receive a cochlear implant, but it is not impossible.

If you have surfer's ear and are considering a cochlear implant, it is important to talk to your doctor or audiologist. They can assess your individual situation and determine if a cochlear implant is right for you.

When to see a specialist

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You should consider seeking the expertise of a specialist for surfer's ear when you encounter persistent symptoms, particularly if you experience recurrent ear infections, water trapped in your ears, or progressive hearing loss. Additionally, if you have concerns about your ear health, large or severe exostoses, or unusual symptoms, it's advisable to consult with an Ear, Nose, and Throat (ENT) specialist. This is especially important for individuals actively engaged in water activities, such as surfers or divers, who should consider regular check-ups with a specialist to monitor their ear health and prevent the progression of surfer's ear. Consulting a specialist ensures timely diagnosis, personalized care, and the best possible management of the condition.

FAQs on surfer's ear

Can surfer's ear cause tinnitus?

Tinnitus, which is characterized by ringing in the ears, is a potential consequence of advanced stages of surfer's ear but is not typically associated with the condition in its early or moderate forms.
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