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Conditions

Surfer's ear

Smooth lumps of bone that grow slowly in the ear canals of people who spend years in cold water and wind. Usually harmless, sometimes troublesome, and largely preventable.

What surfer’s ear is

Surfer’s ear is the everyday name for exostoses of the ear canal: smooth, rounded swellings of new bone in the deep part of the canal, close to the eardrum. They are benign. They do not spread, do not turn into cancer and are not an infection. They usually affect both ears, often as two or three swellings in each canal that slowly grow towards one another.

They form in the inner two-thirds of the canal, where the bone is covered by skin only a fraction of a millimetre thick; this is why surgery on them needs care.

Exostosis or osteoma?

An osteoma is a different bony growth that can look similar. It is usually single, in one ear, attached by a narrow stalk, and sits further out in the canal. It is not linked to cold water. Exostoses are usually multiple, broad-based, deep in the canal and in both ears. The difference matters for surgery: an osteoma on a stalk can often be removed in one piece, whereas exostoses lie against the eardrum and are removed bit by bit. Occasionally a CT scan helps to tell them apart.

Cold water and wind

The canal responds to repeated cooling by laying down new bone in thin layers. The mechanism is not fully understood, but the link with exposure is consistent: the more years, the more sessions and the colder the water, the more likely and the more severe the exostoses.

  • How common. A systematic review of 19 studies, covering almost 3,000 surfers, found exostoses in 53–90%, about two-thirds on average.
  • Years in the water. Among 307 avid surfers, 45% of those who had surfed for ten years or less had normal canals and 6% had severe narrowing; after more than 20 years, only 9% had normal canals and 16% were severely narrowed.
  • Water temperature. In 202 surfers, those who surfed mainly in colder water had almost six times the odds of exostoses, and each additional year of surfing raised the risk by about 12%.
  • Wind. Wind cools a wet canal by evaporation. Among 130 windsurfers and kitesurfers on the German North Sea and Baltic coasts, three-quarters had exostoses and one in five had severe ones, and the growths appeared to progress faster than in surfers.

Sailors, open-water swimmers, divers and kayakers are affected too, though susceptibility varies between individuals.

Symptoms

Most people with exostoses have no symptoms. Problems begin when the passage becomes narrow enough to trap things:

  • Trapped water after surfing or showering, with a blocked feeling that can take hours to clear.
  • Wax and skin debris. The canal normally cleans itself as its skin migrates outwards; bony lumps interrupt this, and debris collects behind them.
  • Recurrent canal infections (otitis externa): pain, itching, discharge and a blocked ear. Each infection swells the skin and can close a narrow canal completely.
  • Hearing loss, which is conductive and appears only when the canal is almost closed, or when a small remaining opening is plugged by water, wax or swelling.

In the German wind- and kitesurfers, symptoms needing treatment became more frequent once about two-thirds of the canal was obstructed. Exostoses do not harm the inner ear; a gradual loss of high-pitched hearing has another cause, such as noise.

Prevention

Exostoses that are present do not shrink, but further growth can be slowed by keeping cold water and wind out of the canal.

  • Earplugs. In a prospective study of 242 ears of surfers in Brittany, the severity of exostoses rose with hours spent in the water unprotected, but not with hours spent wearing earplugs. Ready-made and moulded plugs for water sports exist, some vented to let sound through. They help only if worn every session.
  • A neoprene hood keeps wind and cold off the ear, but in the same study a hood alone did not appear to protect as earplugs did. Many cold-water surfers use both.
  • After a session, tilt the head to let water drain, and avoid cotton buds, which push debris deeper and graze the thin skin.
  • Have the canal checked once water starts to stay in the ear or infections begin.

When surgery is reasonable

Exostoses alone are not a reason to operate. Surgery is usually considered when they cause problems that cleaning, treatment of infections and protection cannot control: repeated canal infections, water or debris trapping that needs frequent cleaning, conductive hearing loss from a nearly closed canal, or a canal so narrow that the eardrum cannot be seen or another ear treatment cannot be reached.

The operation is called canaloplasty (also spelled canalplasty) or exostectomy. As with any ear operation, the question is whether the expected benefit outweighs the risks for this ear and this person. Some surgeons advise not waiting until the canal has closed completely, because the eardrum is then hidden and the operation becomes harder.

How the operation is done

The operation is usually done under general anaesthesia, sometimes under local, and often as day surgery. When both ears need it, they are usually done separately. There are two broad approaches, often adapted or combined:

Through the ear canal (transcanal). Working through the canal with a microscope or endoscope, the surgeon lifts the thin canal skin aside and removes the bone in small pieces with fine chisels (osteotomes), a small drill, or both. In one series of 221 ears treated with transcanal chisels, the canal had healed after an average of three and a half weeks, 90% within four weeks.

Behind the ear (postauricular). An incision in the crease behind the ear gives a wider view. The bone is removed with a drill, and the canal skin is preserved as flaps and laid back. This approach is often chosen for large exostoses at the front of the canal, close to the eardrum. In a series of 401 ears operated on this way, prolonged healing occurred in 4.5%.

Risks

  • Eardrum tears or perforation. In the transcanal series, 29 small tears healed by themselves and one needed a tympanoplasty; in the postauricular series there was one perforation in 401 ears.
  • Slow healing and narrowing (stenosis), when bare bone re-skins slowly and scar tissue forms; occasionally further treatment is needed.
  • Inner-ear hearing. In the postauricular series, hearing at 4 kHz worsened by 3.7 dB on average, and by more than 15 dB in 4.8% of ears; the overall bone-conduction average was unchanged.
  • The jaw joint lies just in front of the canal; removing too much of the front wall can expose it. This is rare.
  • The facial nerve runs just behind and below the deep part of the canal. Injury is rare (none in the 221 transcanal cases), but it is the most serious risk.

Recurrence

Exostoses can grow back if exposure continues. In the postauricular series, 8 of 91 ears with long-term follow-up showed regrowth, up to 15 years after surgery. In a French series of 98 ears, recurrence within three years was 18% for the senior surgeon and considerably higher for less experienced surgeons; nearly half of the ears with recurrence had continued cold-water exposure, against 7% of those without. Earplugs after surgery are part of the treatment.

Recovery and time out of the water

General ranges, which vary between surgeons:

  • Packing in the canal for one to three weeks; the ear feels blocked until it is removed.
  • Keep the ear dry until the canal has healed, typically two to eight weeks depending on the technique; see recovery after ear surgery.
  • Back in the water only once your surgeon confirms the canal has healed, commonly one to two months after surgery, later if healing is slow, and with earplugs from then on.
  • Desk work is usually possible within days to a week.
  • Flying: the middle ear is often not opened, so restrictions may be shorter than after middle-ear surgery; ask your surgeon before planning a flight. See flying after ear surgery.

Follow the advice given for your own operation. A sudden drop in hearing, severe or spinning vertigo, or facial weakness needs care the same day; increasing discharge or pain, fever, or hearing that slips back over several days warrants a call within a day or two. See when to contact your surgeon.

Technical notes for professionals

Exostoses arise medial to the bony-cartilaginous junction and have a laminated histology. Grading by percentage of canal obstruction uses differing cut-offs between studies, which limits comparison of figures. Preserve as much medial canal skin as possible; address the posterior and inferior masses before the anterior one, which overhangs the anterior sulcus; protect the annulus and avoid breaching the glenoid fossa. The facial nerve is most vulnerable posteroinferiorly, where it may lie lateral to the annulus. Chisels avoid drill noise and heat; the drill gives control near the anterior sulcus. Neither instrument nor approach has been tested in randomised trials.

Sources

  • Vallée A. External auditory exostosis among surfers: a comprehensive and systematic review. Eur Arch Otorhinolaryngol. 2024;281(2):573-578. PubMed
  • Wong BJ, Cervantes W, Doyle KJ, et al. Prevalence of external auditory canal exostoses in surfers. Arch Otolaryngol Head Neck Surg. 1999;125(9):969-972. PubMed
  • Kroon DF, Lawson ML, Derkay CS, et al. Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngol Head Neck Surg. 2002;126(5):499-504. PubMed
  • Wegener F, Wegner M, Weiss NM. External auditory exostoses in wind-dependent water sports participants: German wind- and kitesurfers. Eur Arch Otorhinolaryngol. 2022;279(5):2353-2361. PubMed
  • Lambert C, Marin S, Esvan M, et al. Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears. Eur Arch Otorhinolaryngol. 2021;278(12):4775-4781. PubMed
  • Hetzler DG. Osteotome technique for removal of symptomatic ear canal exostoses. Laryngoscope. 2007;117(1 Pt 2 Suppl 113):1-14. PubMed
  • House JW, Wilkinson EP. External auditory exostoses: evaluation and treatment. Otolaryngol Head Neck Surg. 2008;138(5):672-678. PubMed
  • Leclère JC, Cerceau L, Mornet E, et al. External ear canal exostectomy: influence of surgeon’s experience on 3-years recurrence and occurrence of complications. Ear Nose Throat J. 2024;103(6):351-356. PubMed

Common questions

Can surfer's ear go away on its own?

No. Exostoses are bone, and once formed they do not shrink when you stop surfing or start wearing earplugs. What protection does is slow or stop further growth. Many people live with small or moderate exostoses for decades without trouble, managing the occasional trapped water or wax with simple care. Surgery is kept for those whose symptoms cannot be controlled in this way.

Is surfer's ear only a problem for surfers?

No. The name comes from surfing, but the cause is repeated cold water and wind in the ear canal, whatever the sport. Windsurfers, kitesurfers, sailors, open-water swimmers, divers and kayakers develop exostoses too. In studies of wind- and kitesurfers on the German North Sea and Baltic coasts, the exostoses appeared to grow faster than in surfers, probably because wind cools a wet ear canal further.

Do earplugs really prevent surfer's ear?

The available evidence suggests that they help. In a prospective study of surfers in Brittany, the severity of exostoses rose with hours spent in the water unprotected, but not with hours spent wearing earplugs. They need to be worn every session, including short ones, and to fit well. A neoprene hood keeps wind off the ear, but on its own it did not appear to protect in the same way.

Can surfer's ear cause hearing loss?

Only when the canal is almost closed, or when a small remaining opening is plugged by water, wax or the swelling of an infection. Sound passes easily through a narrow canal, so hearing is usually normal for years. The loss, when it comes, is conductive: the inner ear is not damaged, and hearing returns when the canal is cleared or opened. A gradual high-pitched loss has another cause and should be tested separately.

How long after surfer's ear surgery can I surf again?

Only when the canal skin has fully healed, which your surgeon checks under the microscope. In published series most canals heal in about two to eight weeks, so a return to the water somewhere between one and two months after surgery is common, and later if healing is slow. Practice varies between surgeons, so follow the advice given for your own operation, and wear earplugs from then on.

Will the exostoses come back after surgery?

They can, slowly, over years. In one large series, regrowth was seen in fewer than one in ten ears followed for the long term, sometimes up to fifteen years later. In another, recurrence within three years was much more common, and was strongly linked to continued cold-water exposure without protection. Earplugs after surgery are the main thing you can do to keep the canal open.

This page provides general educational information. It cannot replace an individual assessment, which depends on a full history, examination, audiometry and, where relevant, imaging. If you have sudden hearing loss, severe pain, facial weakness, severe dizziness or discharge with fever, seek medical care promptly.