Exostoses (Ear Bony Growths) - Causes, Treatment & When to See a Doctor

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What is Exostoses (Ear Bony Growths)?

Exostoses—often called “surfer’s ear” when they affect the outer ear canal—are benign, bony protrusions that develop in the external auditory canal (EAC). The growths arise from the bone that lines the canal (the temporal bone) and can range from tiny, flat ridges to large, mushroom‑shaped “corkscrews” that significantly narrow the airway.

Although exostoses are non‑cancerous, they can trap water and debris, leading to repeated ear infections (otitis externa), hearing loss, or chronic ear pain. They differ from osteomas, which are solitary, pedunculated bony tumors that typically occur in the same region but have a different cause and appearance.

Common Causes

The exact mechanism that triggers bone growth in the ear is not fully understood, but several risk factors and conditions are repeatedly associated with exostoses. The most important are environmental exposures that create repeated cooling of the ear canal.

• Cold‑water exposure: Frequent swimming, surfing, diving, or water‑sports in water below ~20 °C (68 °F) is the classic cause.
• Repetitive wind exposure: Prolonged wind‑chill on the ear, especially in cold climates (e.g., kite‑surfing, high‑altitude skiing).
• Cold, dry climates: Living in areas with long, chilly winters increases risk even without water exposure.
• Genetic predisposition: Family history may influence the vigor of bone remodeling response.
• Otitis externa (swimmer’s ear): Chronic inflammation can amplify bone growth.
• Middle ear pressure changes: Frequent rapid altitude changes (pilots, divers) may contribute indirectly.
• Chronic ear infections in childhood: Repeated inflammation may act as a “second hit.”
• Radiation therapy to the head/neck: Rare, but can stimulate abnormal bone growth.
• Bone‑forming disorders: Conditions such as Paget disease or osteopetrosis can sometimes involve the ear canal.
• Smoking: Some studies suggest nicotine may affect bone remodeling, though evidence is limited.

Associated Symptoms

Many people with early exostoses have no symptoms. When the growths become large enough to obstruct the canal, a constellation of problems can appear:

• Conductive hearing loss: Sound waves have a harder time reaching the eardrum.
• Ear fullness or “plugged” sensation.
• Recurrent otitis externa: Water becomes trapped behind the bony blockage, leading to bacterial or fungal infection.
• Otalgia (ear pain): Often worsens after swimming or bathing.
• Itching or irritation: Debris accumulates and can cause discomfort.
• Tinnitus (ringing): Present in some patients due to altered sound conduction.
• Vertigo or balance problems: Rare, but can occur if infection spreads to the inner ear.

When to See a Doctor

Because exostoses can be silent until they cause trouble, it’s important to seek evaluation if you notice any of the following:

• Persistent ear fullness or reduced hearing that does not improve after drying the ear.
• Frequent “swimmer’s ear” infections (more than two episodes per year).
• Ear pain that lasts longer than 48 hours after water exposure.
• Visible bony lumps in the ear canal on inspection (often seen by an ENT specialist).
• Discharge (pus or foul‑smelling fluid) from the ear.
• Sudden or rapidly worsening hearing loss.

Early evaluation can prevent the need for more extensive surgery later.

Diagnosis

Clinical Examination

An otolaryngologist (ENT) will use an otoscope or a specialized ear‑canal microscope to look inside the canal. The classic appearance is a series of smooth, symmetrical bony protrusions that narrow the canal lumen.

Imaging

• High‑resolution computed tomography (CT) of the temporal bone: The gold standard; shows exact size, shape, and location of each exostosis and helps plan surgery.
• Digital otoscopy photographs: Useful for monitoring growth over time.

Audiometry

A standard hearing test determines whether the growths are causing a conductive hearing loss and quantifies its severity.

Differential Diagnosis

Conditions that can mimic exostoses include:

• Osteoma (usually solitary and pedunculated)
• Cholesteatoma (skin growth that can erode bone)
• External auditory canal stenosis from trauma or scar tissue

Treatment Options

Conservative / Home Care

• Dry the ears thoroughly: Use a towel or a hair dryer on low, held at least 12 inches from the ear after swimming.
• Ear plugs or custom mold‑made “surfer’s ear” plugs: Prevent water from entering the canal.
• Topical antibiotic or antifungal ear drops: For early infections; follow a provider’s prescription.
• Regular cleaning: Gently remove debris with a cotton‑tip applicator (only after the canal is dry) or have a professional clean it.
• Avoid further cold‑water exposure: If possible, limit time in cold water or wear neoprene ear protection.

Medical / Surgical Intervention

• Observation: Small, asymptomatic exostoses are often monitored with annual exams.
• Canaloplasty (microscopic surgical removal): The most common procedure. The surgeon removes the bony growths using a drill or specialized burr while preserving the ear canal’s skin. Success rates for symptom relief exceed 90% (Cleveland Clinic, 2023).
• Canalplasty with skin graft: Required when large portions of the canal lining are damaged during removal.
• Endoscopic ear surgery: A newer, minimally invasive technique that uses a thin endoscope; results in less postoperative pain and quicker recovery.
• Post‑operative care: Usually involves a short course of oral antibiotics, ear packing to keep the canal open, and follow‑up cleaning.

Prevention Tips

Because exostoses develop as a protective response to chronic cold, the most effective prevention is to reduce that stimulus.

• Wear waterproof ear plugs or custom‑fit “surfer’s ear” plugs whenever you swim, dive, or engage in water sports.
• Use a neoprene headband or “ear hood” in windy, cold environments.
• Limit exposure: Take regular breaks in warm areas during long surf sessions.
• Dry ears promptly: Tilt your head, pull the earlobe down and back, and use a low‑heat hair dryer.
• Maintain good ear hygiene: Avoid inserting objects that can irritate the canal skin.
• Stay up to date on vaccinations: Influenza and pneumococcal vaccines reduce the risk of secondary ear infections that could worsen the condition.
• Quit smoking to improve overall bone health and immune response.

Emergency Warning Signs

Key Take‑aways

• Exostoses are benign bony growths in the outer ear canal, most often caused by repeated cold‑water or wind exposure.
• Early stages may be silent; symptoms arise when the canal becomes narrowed.
• Diagnosis is made with otoscopic examination and confirmed with high‑resolution CT.
• Conservative measures (drying, ear plugs, infection control) help most people; surgery is reserved for symptomatic or progressive cases.
• Preventive ear protection is the single most effective strategy for people who spend time in cold water or windy environments.

For more detailed information, consult reputable sources such as the Mayo Clinic, the CDC, the NIH National Institute on Deafness and Other Communication Disorders, and the Cleveland Clinic.

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