Exostoses are bony growths of the external auditory canal as a result of long term exposure to cold water and wind.
An image showing significant bony narrowing of the external auditory canal. The ear drum cannot be seen due to these growths.
Most of the time either prevention of water entering the ear canal or ensuring any water is removed after swimming will manage the condition adequately. There are a vast array of ear plugs ranging from using blutac, to more advanced plugs such as surfears, and custom made plugs arranged through an experienced audiologist. Aquaear is an alcohol and acetic acid drop that is often helpful in drying the ear after water exposure.
Occasionally when there are recurrent infections, constant blockages, and even hearing loss, surgical intervention (exostectomy) is required. This often occurs when the canal itself is narrowed by more than 80%.
The Exostectomy Surgery for Surfer’s Ear Treatment
Exostectomy is a delicate operation that involves drilling of the bony growths while preserving the skin covering of the bony growths. To optimise clearance and safety, a small incision is made behind the ear. Care must be taken to protect the jaw joint and the tympanic membrane. The major downside of surgery is that the ear remains blocked with packing for approximately 6 weeks. This is to ensure that healthy skin grows to cover the bone of the widened ear canal. Following surgery one can return to swimming and surfing within a few days, with some minor precautions.
Please contact us for a formal assessment, and further information regarding simple control measures or whether the need for more interventional management is required.
Video of exostoses surgery with a Z-plasty meatoplasty
The following are a series of photos showing what is used to pack the ear canal immediately after sugery: this usually stays in for the first 3 weeks. It is then removed and replaced with an antibiotic ointment for a further 3 weeks. This is to ensure that skin grows to cover the widened bony ear canal without infection or scarring. The downside is that there will be no hearing for the first 6 weeks, but it is an excellent ear plug allowing water exposure and swimming.
The ear canal after removal of the exostes. There is a wide view of the tympanic membrane, but never enough skin to cover the widened ear canal
Gelfoam (a disolvable sponge) coated with kenacomb (an antibiotic, antifungal and antiinflammatory ointment) is then used to occlude the medial ear canal. We can also see that a Z-plasty meatoplasty has been performed. This is to widen the opening of the ear to match the widened bony ear canal
BIPP (bismuth iodide paste) covered gauze is then used to occlude the lateral half of the ear canal. This is an excellent ear plaug and also sterilises the ear canal minimising the risk of infection
The limited post-auricular incision is then closed with disolvable sutures. (It will essentially be hiddne in the shadow behind the ear
Steristrips are placed over the incision which normally stay in-situ for 3 weeks
A half a cotton wool ball completely covered with ointment (vaseline or paw paw ointment) is then placed on top of the BIPP gauze. This is so water cannot enter the ear, but also so the cotton wool does not stick to the BIPP gauze. A head bandage is applied for the first night. The cotton wool is then replaced a couple of times a day until the first review. The wound behind the ear can be wet 48 hours after surgery, with the steri-strips patted dry, or a hair dryer can be used on a warm setting. This is a good time to replace the cotton wool ball with ointment.
A series of photos outlining the healing of the ear canal following surgery on the left ear.
