Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Otorhinolaryngol. Feb 28, 2015; 5(1): 14-20
Published online Feb 28, 2015. doi: 10.5319/wjo.v5.i1.14
Exostoses of the external auditory canal
David R Lobo
David R Lobo, Department of Otolaryngology, Hospital El Escorial, San Lorenzo de El Escorial, 28200 Madrid, Spain
David R Lobo, Instituto Antolí-Candela, 28043 Madrid, Spain
Author contributions: Lobo DR solely contributed to this manuscript.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: David R Lobo, MD, PhD, Department of Otolaryngology, Hospital El Escorial, San Lorenzo de El Escorial, Ctra. M-600 de Guadarrama a San Lorenzo de El Escorial, Km. 6,255, 28200 Madrid, Spain.
Telephone: +34-91-8973021 Fax: +34-91-8973031
Received: November 29, 2014
Peer-review started: November 29, 2014
First decision: December 12, 2014
Revised: December 31, 2014
Accepted: January 15, 2015
Article in press: January 15, 2015
Published online: February 28, 2015

Ear canal exostoses are bilateral, usually symmetric multiple bony growths occurring in the medial portion of the external auditory canal. Also known as surfer’s ear, exostosis is thought to be a reactive process from repeated stimulation by cold water and is much more common than external auditory osteoma. Exostoses are usually asymptomatic and discovered on routine otoscopy. Indications for surgical treatment are recurrent otitis externa, hearing loss, otalgia and other conditions in which access medial to the exostoses is required. Surgery is not risk-free and postoperative complications are the most important factor for negative impact on the patient’s health-related quality of life. This review offers an overview of the recent advances in the understanding of this condition, with a special focus on the etiology and physiopathology of this condition, the different surgical procedures and their outcomes, the risk factors for recurrence and the results of preventive measures. Finally, this review suggests the need for the otological surgeon to acquire a great deal of experience before undertaking surgical treatment of exostoses as it is a challenging operation and, besides expertise, demands great patience and extreme care in order to achieve good results.

Keywords: Exostoses, Surfer’s ear, Ear canal, Surgical procedures, Recurrence, Prevention

Core tip: Readers interested in aquatic sports medicine, otological procedures or bone lesions will find in this review a thorough summary of the most relevant aspects of ear canal exostoses, with a special focus on the major advances achieved in the knowledge of its etiology and pathophysiology, prevention and surgical therapy, and the challenges that remain and may guide research in the next few years and beyond, so that complications are minimized and the best outcomes are achieved.