Nonobstructing exostoses of the external auditory canal.

The otoscopic view is of a left ear with four nonobstructing exostoses. Exostoses of the external auditory canal are benign, abnormal growths of bone that develop as semispherical masses beneath the skin and can cause an obstruction. The condition is sometimes called surfer's ear because exostoses tend to develop in people who swim in cold water.

The masses are hard and painless. They are sessile and usually multiple. Exostoses are to be distinguished from osteomas, which are usually solitary and have a thin stalk or neck connecting them to the bone of the ear canal.

No treatment is required unless the patient develops symptoms of recurrent otitis externa or frequent or inconvenient obstruction with debris or water. Repeated exposure to cold water over a period of 20 years is usually required before obstruction develops. In rare cases, a repeat removal is needed in patients who experience continual exposure to cold water. Surgical removal usually involves restoration of the external auditory canal to its normal size with drills and curets via the transcanal approach through a speculum. This is an outpatient procedure that requires only local anesthesia. Care must be taken to elevate and preserve the canal skin so that it can be replaced to obtain prompt healing and avoid stenosis. The operation can be extremely hazardous because of the risk of injury to the tympanic membrane, facial nerve, inner ear, and jugular bulb. Thus, the surgeon must have adequate training and experience in the management of this condition.

From the Pulec Ear Clinic, Los Angeles (Dr. Pulec), and Gap, France (Dr. Deguine).