The evolution of treatment for a distinctly Australian affliction
External auditory canal exostoses are benign, localised bony growths that form in the ear canal. They are classically described as reactive lesions caused by repeated exposure to cold water and wind. This results in chronic inflammation of the periosteum of the external canal leading to the formation of multiple, nodular bony outgrowths of the medial canal that are covered by thin skin. Exostoses tend to remain asymptomatic until they grow to significantly narrow the external auditory canal (Box 1). At this stage, they cause water trapping and hydration of the external canal skin, resulting in recurrent otitis externa. Acute otitis externa (often referred to as swimmer’s ear) is a common complication of exostoses, with management consisting of ear toileting, local antibiotic therapy (drops and ointment), and maintaining a dry ear. In its latter stages, exostoses may completely occlude the external canal, and patients typically present following repeated infection or hearing loss. Anatomically, exostoses typically occur in groups of three: anteriorly, posteriorly and superiorly based. These correspond to the three ossification centres of the tympanic ring, which is the bony structure which supports the ear drum, and the site from which exostoses arise.1
- 1. DiBartolomeo JR. Exostoses of the external auditory canal. Ann Otol Rhinol Laryngol Suppl 1979; 88(6 Pt 2 Suppl 61): 2–20.
- 2. Seftel DM. Ear canal hyperostosis — surfer’s ear. An improved surgical technique. Arch Otolaryngol 1977; 103: 58–60.
- 3. Clarke P, Appel G. Bombora — the story of Australian surfing [film]. Australian Broadcasting Corporation, 2009.
- 4. Surfing Australia. Annual report 2013. https://assets.surfinginaustralia.com/wp‐content/uploads/sites/6/2021/12/08103554/2013‐Annual‐Report‐no‐FR.pdf (viewed Nov 2021).
- 5. Hurst W, Bailey M, Hurst B. Prevalence of external auditory canal exostoses in Australian surfboard riders. J Laryngol Otol 2004; 118: 348–351.
- 6. Rhys‐Evans PH, Cameron M. Surfer’s ear (aural exostoses) provides hard evidence of man’s aquatic past. Hum Evol 2014; 29: 75–90.
- 7. Toynbee J. On osseous tumours growing from the walls of the meatus externus of the ear. Prov Med Surg J 1849; 13: 533–537.
- 8. Mudry A, Hetzler D. Birth and evolution of chiselling and drilling techniques for removing ear canal exostoses. Otol Neurotol 2016; 37: 109–114.
- 9. Clark TE. Electrolysis of exostosis of the ear. Br Med J 1873; 2: 656–657.
- 10. A case of exostosis and mastoid necrosis. Aust Med J 1894; 16.
- 11. Helling TS, Azoulay D. Historical foundations of liver surgery. Cham: Springer, 2020.
- 12. A discussion on the removal of bony growths from the external auditory canal. Br Med J 1889; 2: 704–709.
- 13. Mathewson A. A case of exostosis of the external auditory meatus drilled out by the “dental engine”. Edinb Med J 1876; 23: 467–468.
- 14. Fagan PA. The surgical removal of aural exostoses. J Otolaryngol Soc Aust 1990; 6: 220–221.
- 15. Meller C, Havas TE. Piezoelectric technology in otolaryngology, and head and neck surgery: a review. J Laryngol Otol 2017; 131 Suppl S2: S12–S18.
- 16. Simas V, Hing W, Rathbone E, et al. Auditory exostosis in Australian warm water surfers: a cross‐sectional study. BMC Sports Sci Med Rehabil 2021; 13: 52.
- 17. Wong BJF, Cervantes W, Doyle KJ, et al. Prevalence of external auditory canal exostoses in surfers. Arch Otolaryngol Head Neck Surg 1999; 125: 969–972.
- 18. King JF, Kinney AC, Iacobellis SF, et al. Laterality of exostosis in surfers due to evaporative cooling effect. Otol Neurotol 2010; 31: 345–351.
- 19. Simas V, Hing W, Furness J, et al. The prevalence and severity of external auditory exostosis in young to quadragenarian‐aged warm‐water surfers: a preliminary study. Sports 2020; 8: 1–9.
- 20. Australian Institute of Health and Welfare. Procedures data cubes, 2009–2020. https://www.aihw.gov.au/reports/hospitals/procedures‐data‐cubes/contents/data‐cubes (viewed Nov 2021).
- 21. Lambert C, Marin S, Esvan M, Godey B. Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears. Eur Arch Otorhinolaryngol 2021; 278: 4775–4781.
- 22. Chaplin JM, Stewart IA. The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol Allied Sci 1998; 23: 326–330.
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