```html

Exostoses (Ear Canal Bone Growths)

What is Exostoses (ear canal bone growths)?

Exostoses, also called surfer’s ear or external auditory canal osteomas, are benign bony protrusions that develop within the outer (external) auditory canal. They arise from the bone that lines the ear canal (the tympanic part of the temporal bone) and can range from small, smooth ridges to large, mushroom‑shaped growths that partially or completely block the canal.

Although they are non‑cancerous, exostoses can trap water, debris, and earwax, leading to recurrent infections (otitis externa), hearing loss, and discomfort. The condition is most common in adults who spend a lot of time in cold or windy water, but it can also occur in people without water‑sport exposure.

Sources: Mayo Clinic, CDC, American Academy of Otolaryngology‑Head and Neck Surgery (AAO‑HNS)​.

Common Causes

The exact mechanism is not fully understood, but repeated exposure to cold water and wind appears to stimulate bone growth in susceptible individuals. The following factors are frequently implicated:

• Cold‑water exposure – Swimming, surfing, kayaking, or diving in water colder than 70 °F (21 °C).
• Repeated wind exposure – High‑velocity wind while in the water or during water‑sports activities.
• Prolonged ear canal irritation – Frequent ear cleaning, use of cotton swabs, or repeated ear infections.
• Genetic predisposition – Family history of exostoses suggests a hereditary component.
• Age – Most common in adults aged 20‑50, when bone remodeling is active.
• Osteochondroma syndrome – Rare hereditary condition that can cause multiple bone growths, including in the ear canal.
• Chronic otitis externa – Ongoing inflammation may stimulate bone formation.
• Smoking – Tobacco smoke can impair blood flow and increase inflammatory responses in the ear canal.
• Medication that affects bone metabolism – Long‑term use of steroids or bisphosphonates may alter bone turnover.
• Radiation exposure – Rarely, localized radiation therapy to the head/neck can provoke abnormal bone growth.

While cold‑water exposure is the most recognizable risk factor, many individuals develop exostoses without a clear link to water activities, highlighting the role of genetics and other environmental influences.

Associated Symptoms

Many people with exostoses are asymptomatic, especially when the growths are small. When symptoms do appear, they often include:

• Feeling of fullness or blockage in the ear.
• Recurrent ear infections (otitis externa) characterized by pain, itching, and drainage.
• Decreased hearing, especially for low‑frequency sounds.
• Ringing in the ears (tinnitus).
• Water that becomes trapped after swimming, leading to “swimmer’s ear.”
• Ear pain or pressure that worsens with temperature changes.
• Occasional dizziness or balance problems if the canal becomes severely obstructed.

Symptoms often worsen after water exposure because the canal cannot drain properly, creating a moist environment that promotes bacterial or fungal growth.

When to See a Doctor

Prompt evaluation is recommended if you experience any of the following:

• Persistent ear pain that does not improve after a few days of home care.
• Discharge (clear, yellow, or pus‑filled) from the ear lasting more than 48 hours.
• Noticeable hearing loss or a feeling that your ear is “plugged” even after drying.
• Recurrent episodes of swimmer’s ear (≥3 infections in a year).
• Bleeding from the ear canal after cleaning or water exposure.
• Any sudden, severe ear pain or vertigo.

Early assessment can prevent complications such as chronic infection, permanent hearing loss, or the need for more extensive surgery.

Diagnosis

Evaluation typically involves a combination of history‑taking, visual inspection, and imaging:

1. Medical history & physical exam – Your clinician will ask about water‑sport activities, previous ear infections, and symptom pattern.
2. Otoscopy – A handheld otoscope or a specialized microscope allows the doctor to look directly into the ear canal and assess the size, number, and shape of the bony growths.
3. Audiometry – A hearing test determines whether the exostoses are affecting sound transmission.
4. CT scan of the temporal bone – Provides detailed cross‑sectional images, helping to map the extent of bone growth and plan surgical removal if needed.
5. Culture of ear discharge – If infection is present, a swab may be sent to the lab to identify bacteria or fungi and guide appropriate medication.

Most cases are diagnosed with otoscopy alone; imaging is reserved for large or ambiguous lesions.

Treatment Options

Management depends on symptom severity and the degree of canal obstruction.

Conservative/Home Care

• Dry the ears thoroughly after water exposure—tilt the head, use a soft towel, or employ a handheld hair dryer on low, cool setting.
• Ear drops (alcohol‑based or acetic acid solutions) help evaporate trapped water and reduce bacterial growth. Over‑the‑counter products such as “Swim-Ear” are commonly used.
• Avoid cotton swabs and other objects that can traumatize the canal and exacerbate inflammation.
• Topical antibiotics or antifungals—prescribed if an infection is present.
• Protective ear plugs—custom‑molded or high‑filtration “surfer’s plugs” can limit cold‑water exposure.

Medical/Surgical Interventions

1. Medication – Oral antibiotics for bacterial otitis externa, antifungal agents for fungal infections, or short courses of oral steroids to reduce severe inflammation.
2. Canaloplasty (microsurgical removal) – Indicated when exostoses block ≥50 % of the canal, cause recurrent infections, or lead to hearing loss. Performed under general anesthesia; bone is removed with a drill or curette, and the canal is reshaped.
3. Endoscopic ear surgery – A minimally invasive technique using a small camera, resulting in less postoperative discomfort and faster recovery.
4. Staged procedures – In extensive disease, the surgeon may remove growths in two separate operations to minimize swelling and preserve ear structure.

Post‑operative care includes keeping the ear dry for 1–2 weeks, using prescribed ear drops, and attending follow‑up visits to monitor healing.

Prevention Tips

While you cannot completely stop bone growth once the process has begun, you can reduce the risk of developing exostoses or prevent them from worsening:

• Use ear protection when swimming, diving, or surfing in cold water—silicone or custom plugs that seal the canal.
• Limit duration of cold‑water exposure—take regular breaks and warm up between sessions.
• Dry ears promptly after any water contact.
• Avoid inserting objects (cotton swabs, hairpins) into the ear canal.
• Maintain good ear hygiene—clean only the outer ear with a washcloth.
• Manage ear infections early to prevent chronic inflammation.
• Quit smoking – Improves overall circulation and reduces inflammatory stimulus.
• Regular otoscopic check‑ups for frequent water‑sport athletes, especially if you notice a sensation of blockage.

Emergency Warning Signs

Key Take‑aways

Exostoses of the ear canal are benign bone growths most often linked to repeated cold‑water and wind exposure. While many people remain symptom‑free, larger growths can trap water, cause infections, and lead to hearing loss. Early recognition, proper ear hygiene, and protective gear are essential for prevention and for keeping symptoms manageable. When the condition causes recurrent infections or significant blockage, surgical removal offers a definitive solution.

For personalized advice, always consult an otolaryngologist (ENT specialist) who can assess the extent of the growths and recommend the most appropriate treatment plan.

---

References:

• Mayo Clinic. “Exostosis (surfer’s ear).” mayoclinic.org
• American Academy of Otolaryngology‑Head and Neck Surgery. “External Auditory Canal Exostoses.” entnet.org
• CDC. “Preventing swimmer’s ear.” cdc.gov
• NIH National Institute on Deafness and Other Communication Disorders. “Ear Infections.” nidcd.nih.gov
• Cleveland Clinic. “External Auditory Canal Exostoses (Surfer’s Ear).” clevelandclinic.org

```