Auditory canal exostosis refers to benign bony growths in the bony, posterior portion of the external auditory canal, which cause narrowing or even obstruction of the auditory canal. Single solid growths may develop or multiple smaller pearl-like structures may form. Irritation of the periosteum in the external auditory canal by cold water is considered one of the most common causes because the condition is very common in surfers, for example.
What is ear canal exostosis?
The external auditory canal (meatus acusticus externus) consists of a cartilaginous, elastic substance in the first third and bony structures further inside. In the bony part of the auditory canal, benign growths may occur (hyperostosis), which narrow the external auditory canal or, in extreme cases, displace it completely. Because such bony formations occur only in the inner part of the external auditory canal, they are often located in the immediate vicinity of the eardrum. Benign auditory canal exostosis must be distinguished from other benign or malignant tumorous growths in or on the external auditory canal, which, however, are very rare. The pathological changes in the meatus acusticus externus occur very frequently in surfers and in apnoea divers, so that the term surfer’s ear has become established in Anglo-Saxon usage. The narrowing in the ear canal caused by one or multiple exostoses can be easily seen by otoscope.
Causes
The exact causes of ear canal exostosis are not all known (yet). It is thought to be an acquired, multifactorial disorder. Specific genetic predispositions are considered unlikely. One of the main causes of ear canal exostosis appears to be the frequent entry of water into the external ear canal. Up to 70 percent of surfers who play their sport intensively are affected by such bony growths in their external ear canals. Cold–water surfers appear to be more susceptible than surfers who primarily practice their sport in tropical regions. This means that cold water exerts a stronger stimulus to form exostoses than relatively warm seawater. This furthers the hypothesis that it is actually a kind of protective mechanism to keep cold water away from the eardrum. It is also noteworthy that hooded seals living in Arctic waters, for example, regularly form auditory canal exostoses to protect their hearing.
Symptoms, complaints, and signs
Initial signs and symptoms that may indicate an ear canal exostosis are relatively nonspecific, such as water remaining in the ear canal after bathing or showering, or earwax (cerumen) that does not empty from the ear canal on its own, and frequent inflammation of the ear canal. Occasionally, discomfort that occurs when wearing hearing protection may also indicate a growth in the ear canal. Frequently, a complaint of conductive hearing loss manifests when the external ear canal is severely narrowed or completely obstructed by cerumen or by water. In many cases, the signs and symptoms are so minor that they are not consciously noticed and the ear canal exostosis is more likely to be noticed by chance during another examination with an otoscope.
Diagnosis and course
Auditory canal exostosis is benign bony hyperplasia in the bony portion of the external auditory canal. The bony formations themselves do not cause any systemic problems. They can be diagnosed relatively easily by eye using an otoscope. Further investigation by computed tomography is usually not necessary. The actual problems arise from the physical constriction or even complete obstruction of the meatus acusticus externus. This can cause secondary problems such as hearing loss, and it can lead to a susceptibility to inflammation. The course of the disease depends mainly on the course of irritation of the periosteum in the auditory canal. This means that the hyperplasias will continue to grow as long as, for example, the constant penetration of (cold) water continues. If the disease is detected before symptoms develop, further progression can be stopped if preventive measures such as the use of suitable earplugs or other appropriate protective measures prevent water from entering the ears.If no such measures are taken and irritation of the periosteum persists, bony hyperplasia will continue to increase until complete obstruction of the external auditory canal occurs.
Complications
Ossicular exostosis causes the patient to develop growths in the area of the ear canal. Various complications can occur that affect the ear. In the worst case, the affected person loses all hearing or suffers from pronounced hearing loss. Inflammation of the ear canal can easily occur, especially after bathing and showering or after a visit to the swimming pool. These are associated with severe pain. Not infrequently, pain from the ears also spreads to the head or to the teeth. The quality of life decreases considerably due to the ear canal exostosis. Furthermore, the symptoms can occur even if the patient wears hearing protection. This may mean that certain work or activities are no longer possible, so that the daily life of the affected person is also restricted. For many people, sudden hearing loss leads to psychological discomfort and depression. As a rule, treatment is always necessary, since the ear canal exostosis does not disappear on its own. Surgical interventions are used for this purpose. Hearing loss cannot be reversed in most cases, so the affected person will suffer from it for the rest of his or her life. Likewise, contact with cold water should be avoided. Life expectancy remains unchanged by auditory canal exostosis.
When should one go to the doctor?
If the affected person is unable to remove absorbed water in the ear by himself after bathing, showering or swimming, he should see a doctor. Prior to this, attempts should be made to carefully remove the water from the ear themselves by hopping on one leg and tilting the head. If this does not succeed despite numerous efforts over several days, a doctor should be consulted. In case of numbness, unusual ear noises or a feeling of pressure in the ear, it is advisable to consult a doctor. If pain occurs in the ears, hearing loss sets in or warning signals from the environment can no longer be perceived as usual, a clarification of the complaints is necessary. If the complaints increase in intensity or become more widespread, a visit to the doctor is necessary. If there are headaches, a feeling of pressure inside the head, skin sensitivity on the ear, skin changes, redness and swelling, a doctor is needed. If anxiety develops, social withdrawal occurs, or sports activities can no longer be performed as usual, a doctor should be consulted. If there are disturbances of balance, unsteadiness of gait or dizziness, a doctor must be asked for help. The general risk of accidents increases and should be minimized by clarifying the causes.
Treatment and therapy
The progression of ear canal exostosis can be stopped by eliminating the cause, but the pre-existing hyperplasias do not regress. Also, no medications exist whose use would cause the bony formations to regress. If the constrictions of the external auditory canal do not pose a risk of secondary damage, such as an increase in the frequency of inflammation or a conductive hearing loss, no further therapy is necessary except the recommendation to have an otoscopy performed at regular intervals. If regression or complete removal of bony hyperplasia is indicated, surgical intervention is necessary. The procedure is usually performed under local anesthesia, rarely under general anesthesia. After the skin over the bony tissue to be removed has been folded back, the bony formation is milled away by diamond drill or separated with a tiny chisel. It may be necessary to implant autologous skin, preferably taken from behind the ear, into the ear canal. If the ear is not protected from cold water penetration after the procedure, recurrent growths may occur.
Outlook and prognosis
An ear canal exostosis is a benign bone growth whose outlook and course are very difficult to predict. The overall course of the disease is very much dependent on whether medical or surgical intervention takes place. If the affected person consults a doctor at an early stage and at the first signs of an ear canal exostosis, then the entire course of the disease can be positively influenced.However, medications have no effect on an existing ear canal exostosis, so that a surgical intervention is necessary for improvement. However, such an operation is not always necessary. If the benign growth does not affect the function of the ear, surgery is not necessary. If the auricle or the general hearing is affected by the growth, surgery is inevitable. The growths are removed, so that this can be remedied quickly. For a quick and uncomplicated healing, the advice of an appropriate physician should always be sought, otherwise it can lead to a significantly more difficult course of the disease.
Prevention
The only preventive measures that protect against ear canal exostosis are to protect the external ear canal from the penetration of cold water and cold air. In this way, the periosteum in the bony part of the external auditory canal is not given an incentive to form hyperplasia. In addition to two-component silicone spheres, which can be used to form individual hearing protection, reusable earplugs specially designed for water and surfing sports are particularly suitable.
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Aftercare
In the case of ear canal exostosis, those affected usually have no options for aftercare. At the same time, a complete cure cannot always be achieved, so sufferers are primarily dependent on early diagnosis and treatment of this disease. Self-healing also does not occur with ear canal exostosis. The options for treating ear canal exostosis are also very limited, so that the disease cannot be treated with the help of medication. In rare cases, surgical intervention is required if the cause of the symptoms is known. After such an operation, the affected person should always rest and take care of the body. The ears, in particular, must be spared, and loud noises should be avoided. In general, the affected person must rest and not perform any strenuous activities. The ear should be protected especially from foreign bodies or from water after the procedure. If the ear canal exostosis cannot be treated, the affected person is usually dependent on psychological support. This can also be provided by the patient’s own friends and family. As a rule, auditory canal exostosis does not affect the life expectancy of the affected person.
What you can do yourself
Ear canal exostosis can be prevented in many cases by avoiding the penetration of very cold water into the ear. Surfers in particular should therefore always wear protection while surfing to prevent this penetration. Silicone balls or ordinary hearing protection designed for these sports are suitable for this purpose. Ear canal exostosis can also be formed when warm water penetrates, but the likelihood of formation is significantly increased in cold water. Unfortunately, further treatment with self-help remedies is not possible. In the case of ear canal exostosis, patients always depend on surgical intervention to remove the growths. Usually, this can completely limit the symptoms. However, the ears must continue to be protected from cold water even after successful surgery to prevent the recurrence of the disease. Treatment of ear canal exostosis with medication is not possible. If treatment does not occur, those affected usually suffer from hearing loss. This cannot be alleviated by a hearing aid because the eardrum is not damaged by ear canal exostosis in most cases.
