Tue, Mar 20, 2018




24 October 2014

Surfer's ear

Surfer 200px

“Exostosis of the external ear canal is a disease unique to man. It has been identified in prehistoric man...” according to DiBartolomeo, in a paper titled ‘Exostoses of the external auditory canal’[1]. Aural exostoses are typically firm, sessile, multi-nodular 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. Also known as “Surfer’s ear”, since the most common cause of exostosis is frequent exposure to cold water, making this a condition that affects surfers at a higher rate than the average population[2]

Exposure to wind and cold water causes the bone surrounding the ear canal to thicken and constrict the ear canal, sometimes to the point of complete blockage (known as “occlusion”) which can lead to substantial conductive hearing loss. An exostosis growth can result from any activity that exposes the participant to cold, wet and windy conditions such as skiing, kayaking, fishing, sailing or diving.

Water temperatures around Ireland and Great Britain can range from as low as 5-6 oC in the winter to 15-16 oC in the summer. These temperatures combined with wind chill are the major factors in the development of surfers’ ear. It is thought that cold water entering the ears produces an increased blood flow which stimulates the bone formation. Evidence suggests Surfer’s ear can develop in as little as 5 years of regular cold water surfing if your ears are unprotected[3]. Incidentally, research conducted in the DiBartolomeo paper, in examining 11,000 patients during a ten-year period found that the incidence of exostoses was 6.36 per 1,000 patients examined for otolaryngologic disease. The advancement of Surfer’s ear is painless, they suggest, until the tenth year of aquatic exposure to irritation, when symptoms of obstruction occur. The hearing loss associated with exostoses is usually a conductive type, secondary to occlusion of the canal by impacted cerumen or acute otitis externa (Swimmer’s Ear). Most patients who develop an exostosis are in their mid-to-late 30s but those with significant cold water exposure such as surfers can develop the condition earlier. This is due to the slow progression of bone growth from years of cold weather exposure.

Exotosis surfers ear 400px

In summary, the key facts are:

  • In general, one ear may be much worse than the other. If so, this may be due to the prevailing wind direction in the areas most visited by surfers.
  • The widespread use of better wetsuits and dry suit technology has allowed people to participate in water sports in much colder waters, likely increasing the incidence and severity of exostosis for those who do not use proper ear protection.
  • Cold water surfers experience exostosis at a rate 600 % higher than warm water surfers.
  • The colder the water, the quicker exostoses grow.
  • Surfer's ear is not necessarily harmful by itself, but constriction of the ear canal makes it difficult to drain water and ear wax and other debris can get trapped within the ear canal, which may lead to painful and repeated ear infections. These ongoing infections can result in permanent hearing loss.


 [1]   DiBartolomeo, JR., “Exostoses of the external auditory canal” Ann Otol Rhinol Laryngol Suppl. 1979 Nov-Dec;88(6 Pt 2 Suppl 61):2-20.
 [2]   California Ear Institute
 [3]   Royal Cornwall Hospitals (NHS Trust)





The symptoms can include:

  • Ear pain, itchy ears, discharge
  • Plugging sensation
  • A decrease in hearing sensitivity possibly combined with an increased prevalence of ear infections.
  • Water trapping in the ear canal after swimming. Sometime thereafter, debris trapping and infections.


In the first instance it is important to consult your GP in these matters. Prompt treatment can help prevent complications and more-serious infections. Exostosis is difficult to diagnose and manage without a comprehensive medical examination and specialty care from an Otolaryngologist (ENT). Exostosis is most commonly treated by a surgical procedure to remove the growth.

If a preceived loss of hearing is experienced then contact earpeace™ to arrange an appointment with one of our Audiologists.


earpeace™ has a range of products that swimmers and surfers can wear to protect their ears from water ingress. We recommend our customised catamaran ear moulds for surfing or wind surfing. Custom ear moulds are created by making an impression of the ear canal from which the customised ear mould is manufactured. These are more comfortable and work much better than over-the-counter one-size-fits-all solutions you may see.


earpeace™ is a privately owned Irish Company, with its head office located in Galway, Ireland. The company is committed to providing exemplary audiology services and associated world leading technology products to its customers throughout Ireland. For further information about the company, please follow this link. 

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