Spending time in or on the water—whether you’re swimming, kayaking, fishing or surfing—can provide endless relaxation, fun and exercise. However, as exciting as time in the water can be, it’s also important to be aware of how exposure to water, specifically very cold water and wind, can negatively affect your ear and hearing health. Read on to learn how a condition known as surfer’s ear can occur and how you can prevent it while still enjoying the activities you love.
Surfer’s ear exostosis, also known as external audio exostosis, is a slow-progressing condition where the bones of the ear canal develop bony growths called exostoses. While it is often asymptomatic, these ear canal bone growths can lead to a partial or complete ear canal obstruction if left untreated. As its name might suggest, the condition is primarily associated with surfers—but it can affect any person who is repeatedly exposed to cold water, including swimmers, divers, kayakers and sailors.
Exostoses are bone tumors that develop on top of existing bone tissue, similar to a bone spur. Think of them as bumps growing out of your bones. While that may sound concerning, exostoses are benign and won’t spread to other parts of the body. These bony growths can cause some pain, depending on the location in the body, or they may go undetected until discovered by a healthcare provider. While most exostoses develop without a known cause, the most common causes are bone injuries, health conditions like osteoarthritis or genetics.
In the context of exostosis and surfer’s ear, these bony growths form on the tympanic ring in the external auditory canal. This ring is connected to the temporal bone in the skull and is located within the middle ear, between the eardrum and the oval window. These bony growths in the ear canal often occur in both ears and can occur along the temporal bone.
While exostoses in general can be caused by several factors, surfer’s ear causes boil down to regular or prolonged exposure to cold water and wind. In fact, the development of exostoses is considered to be the body’s way of protecting the sensitive structures of the inner ear from cold water and wind.
While the exact process is still unknown, most doctors believe that the condition is caused by the body’s natural response to expand blood vessels and increase blood flow circulation when exposed to cold water or wind. Regular blood vessel expansion—known as vasodilation—can cause inflammation of the membranes of the tympanic bones, which can ossify into new bone growth. Put more simply, as the blood vessels expand in response to regular cold water exposure and come into contact with the surface of the ear’s bones, the inflammation caused by this irritation can solidify into new abnormal bony growths on the bones of the ear.
After simply hearing the name “surfer’s ear,” it can be easy to connect this condition to another similar condition related to ear health and water: swimmer’s ear. However, while these two ear conditions sound similar, they are actually very different. Here are the three key differences between surfer’s and swimmer’s ear.
The severity of these complications is directly related to the size of the bone growths. These complications can progress with time, especially with continued exposure.
Conductive hearing loss, or a type of hearing loss caused by issues in the outer or middle ear, is a very common complication of surfer’s ear. As the blockages by the bone growths in the ear canal become more severe, sound cannot be conducted effectively through the middle ear and the ear drum. This causes the sounds that do reach the inner ear to become very diminished and more difficult to process as sound.
This progression of the bone growths can also lead to earwax buildup, which has a negative effect on hearing, as earwax and debris become trapped by the bone growths in the ear canal. It’s this buildup that can create the perfect conditions for bacteria growth in the ears, causing earaches, chronic ear infections, and water trapping in the ears.
In severe cases of surfer’s ear, the buildup of debris in the ears can put excessive pressure on the tympanic membrane. This thin layer of tissue, which separates the outer ear from the middle ear, plays a key role in processing soundwaves to the inner ear and protecting the sensitive inner structures of the ear from unwanted dirt and debris. Additional pressure on the tympanic membrane can cause the tissue to perforate or rupture, putting the person with surfer’s ear at greater risk of serious ear infections—especially with continued exposure to saltwater. If not addressed, this can cause permanent hearing loss.
Because it remains undetectable for so long, a surfer’s ear diagnosis can be hard to come by, since it’s often not immediately noticeable. People experiencing the condition will likely visit their hearing care provider with a complaint of ear pain, some hearing loss or a feeling of fullness in the ears.
From there, your doctor will be able to officially diagnose the condition by reviewing your hearing health history and lifestyle, and examining your ears through an otoscopy, which involves examining the ear canal, tympanic membrane and middle ear. Your doctor would likely be able to see numerous firm, bony growths on the tympanic ring of the middle ear. Your doctor may also perform a hearing test to determine the degree of ear canal disruption caused by the exostoses. In most cases, surfer’s ear appears in both ears.
Once your doctor can assess how surfer’s ear is affecting your hearing health, they will be able to recommend treatment options to properly address your symptoms. Unlike swimmer’s ear, which can be easily treated with antibiotics to fight bacteria growth in the ear, surfer’s ear treatment can be a little bit more involved. Once the bone growths themselves are formed, they can only be reversed with the help of surgical interventions. In severe cases of surfer’s ear, where the exostoses have significantly built up in the ear canal, your doctor will likely recommend a canalplasty. This surfer’s ear surgery, usually performed by an otolaryngologist, is performed to widen the ear canal. In the case of surfer’s ear, that can look like chiseling or shaving down the bone growths. While canalplasties are effective and can improve hearing health, this surgery is usually reserved for very severe cases of exostoses and for people who are experiencing significant complications as a result of their condition.
Because of the progressive nature of the condition, regular non-surgical medical management is also necessary, including proactively managing earwax buildup to keep ears as clean as possible to help prevent ear infections and hearing loss.
Overall, the best way to treat surfer’s ear is through early detection and by consistently taking preventative measures to protect your ear and hearing health.
In simplest terms, the best way to prevent surfer’s ear is to prevent or limit your ear’s exposure to cold water. This doesn’t mean stopping the activities you love—it just means protecting your ears from cold water entering. By consistently using ear protection during cold water exposure, you can prevent water from entering the ear canal and limit the development and progression of bone growths. Here are two specific surfer’s ear prevention tips:
Once you’re out of the water, it’s important to effectively dry your ears to prevent bacteria forming in water in the ear canal. After swimming or surfing, tip your head to the side to help water drain from the ear canal. Using a soft, dry towel, gently wipe the outer ear dry. Be sure to fully dry the ears after any time in the water.
While most cases of surfer’s ear are asymptomatic, some symptoms—including hearing loss, chronic ear infections and tinnitus—can be an indication that you’re experiencing surfer’s ear. Tinnitus, or the perception of sounds that aren’t really there, is likely the result of the blockages created by the bone growths in the ears.
Experiences of tinnitus as a result of surfer’s ear may also be a result of the blood vessel expansion caused by cold water exposure. Consistent cold water exposure causes the blood vessels, including those in or near the ear, to expand, altering blood flow. This increase in blood flow can create a whoosing sound in the ears most commonly associated with pulsatile tinnitus.
If you begin to experience tinnitus after years of cold water exposure, schedule an ear exam and discuss your symptoms with a hearing care professional.
Given its relation to cold water and wind, surfer’s ear is more prevalent in coastal regions where water—especially cooler water—is more common. Surfers are at a higher risk of developing the condition than other cold-water sports, such as kayaking or sailing, likely due to the nature of the sport and direct exposure to the water.
Among surfers, the likelihood of the condition ranges between 26% to 73%. Studies have found that each year of exposure to cold water increases the risk for the development of surfer’s ear by 12%, making exostoses more prevalent for surfers who have been surfing in cold climates for many years.
The time it takes to develop surfer’s ear is directly related to the amount of time spent in cold element and how cold the conditions are—the more frequent the exposure to cold water and wind, the faster the condition can develop. Despite this positive relationship between frequency of exposure and time of development, it can still take years to develop surfer’s ear even for regular surfers.
A 1996 study of Oregon surfers found that unless the surfer was exposed to cold water more than 50 times in a year, people who have surfed for less than five years were unlikely to develop bone growths. In most cases, a case of surfer’s ear that impact hearing and health can take many years to develop. However, if you are genetically predisposed to develop bony growths or have sustained injuries that cause exostoses to develop, you may experience surfer’s ear more quickly than others.
Understanding surfer's ear is essential for anyone exposed to cold water conditions. Early detection and prevention are key in managing this condition, which can lead to hearing difficulties due to bony growths in the ear canal. By taking proactive measures, such as wearing ear protection, you can significantly reduce your risk. If you have concerns about surfer's ear or want to learn effective strategies to protect your hearing, schedule an appointment with a hearing care specialist at your local Miracle-Ear. They’ll offer personalized advice and ensure your ears are safeguarded from cold water exposure.
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