13,14 Exposure to cold water and wind are recognised risk factors. The risk of EAE increases after five sessions of surfing per month and significantly increases after five years of surfing. It is well known that EAE is highly correlated with the amount of time spent in the water.
Cold water and air exposure are believed to stimulate osteoblasts within the temporal bone, leading to bone growth into the EAC, possibly as a mechanism to protect the tympanic membrane against low temperatures. The precise mechanism for the development of EAE remains unknown. 3 However, our recent study investigating injuries while surfing via an online survey identified only 3.5% of the participants reporting exostoses. 8,9 A study in Victoria reported that 78% of male surfers and 69% of female surfers had some degree of exostoses a severe grade (ie Grade 3) was observed in more than 50% of the male surfers diagnosed.
Surfer 9 key professional#
The prevalence of this condition in surfers, both professional and recreational, is 38–80% when investigated by otological examination. Otolaryngol Head Neck Surg 2011 145(1):80–85 with permission from SAGE Publications, Inc. Incidence of external auditory canal exostoses in competitive surfers in Japan. Grades 1–3 reproduced from Nakanishi H, Tono T, Kawano H.
Otoscopic image identifying the four grades of EAE
Grade 0 – normal ear canal, no visible exostosisįigure 2. Patients may also present with recurrent otitis externa, otalgia and conductive hearing impairment due to stenosis of the EAC.ĮAE can be classified into four grades of severity based on the percentage of obstruction of the EAC, as assessed by otoscopy (Figure 2): 7 Patients can present with a prolonged blocked feeling in the ears following water activities because of water trapping in the EAC or chronic cerumen impaction. Typically found bilaterally with multiple lesions, EAE is usually asymptomatic and hence is often diagnosed when the condition is at an advanced stage, 6 leading to a higher incidence of potentially serious health issues. Australia is recognised as having a high prevalence of EAE. EAE is commonly referred to as surfer’s ear, although it has also been described in other aquatic sports. This condition is a benign and irreversible, broad-based bone outgrowth that arises from the temporal bone and projects into the external auditory canal (EAC). 2 One of the chronic conditions associated with surfing is external auditory exostosis (EAE). 1 In Australia, this number is estimated at 2.7 million, which accounts for more than one in 10 Australians. Surfing is a popular recreational activity and competitive sport, with an estimated 37 million surfers worldwide. When is it appropriate to refer a patient with surfer’s ear to a specialist? Answer 1 What is the treatment of surfer’s ear? Question 10 What are the differential diagnoses of someone suspected of having surfer’s ear? Question 8 How is surfer’s ear diagnosed? Question 7 What are the risk factors of surfer’s ear? Question 6 What are the pathophysiology and aetiology of surfer’s ear? Question 5 What is the prevalence of surfer’s ear in surfers? Question 4 What is the clinical presentation of surfer’s ear? Question 3 Otoscopic image identifying auditory exostoses in a young male competitive surfer Question 1 He had been surfing for 11 years and denied participating in any other form of water activity.įigure 1. A previously healthy, competitive surfer (male, aged 23 years) from the Gold Coast presented with chronic ear discomfort, having noticed frequent water trapping in the ear canal (Figure 1).
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