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European Archives of Oto-Rhino-Laryngology

Published in:

30-09-2023 | Review Article

External auditory exostosis among surfers: a comprehensive and systematic review

Author: Alexandre Vallée

Published in: European Archives of Oto-Rhino-Laryngology | Issue 2/2024

Abstract

Objective

External auditive exostosis (EAE), known as surfer’s ear, is a temporal bone outgrowth resulting from ear exposure to cold air and water. This review aims to shed light on the prevalence of EAE among worldwide surfers.

Methods

By a thorough retrieval of the PubMed, we found all original investigations performed on EAE among suffers. The retrieval time was from the construction of the database to December 2022. Agency for Healthcare Research and Quality (AHRQ) methodology checklist for assessing the quality of cross-sectional/prevalence study was performed.

Results

19 articles were selected involving 2997 surfers on whom 2032 presented EAE. The prevalence of EAE was ranged from 53 to 90% with a mean at 67.8%. 3 investigations were performed from USA, five from UK and Ireland, five from Australia and New Zealand and six from Japan and Europe.

Conclusion

Cold water exposure, combined with wind and prolonged surfing activity, contributes to the development of EAE. Symptoms range from mild discomfort to hearing loss and recurrent infections. Preventive measures, such as raising awareness and promoting the use of ear protection, are crucial. Further research is needed to improve prevention strategies and understand the underlying mechanisms of EAE.

Available only for authorised users

Arnold BF, Schiff KC, Ercumen A, Benjamin-Chung J, Steele JA, Griffith JF et al (2017) Acute illness among surfers after exposure to seawater in dry- and wet-weather conditions. Am J Epidemiol 186:866–875. https://doi.org/10.1093/aje/kwx019CrossRefPubMedPubMedCentral

Kroon DF, Lawson ML, Derkay CS, Hoffmann K, McCook J (2002) Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 126:499–504. https://doi.org/10.1067/mhn.2002.124474CrossRef

Simas V, Furness J, Hing W, Pope R, Walsh J, Climstein M (2016) Ear discomfort in a competitive surfer. Aust Fam Physician 45:644–646PubMed

Landefeld K, Bart RM, Lau H, Cooper JS (2021) Surfer’s ear. StatPearls Publishing, Treasure Island

Reddy VM, Abdelrahman T, Lau A, Flanagan PM (2011) Surfers’ awareness of the preventability of “surfer’s ear” and use of water precautions. J Laryngol Otol 125:551–553. https://doi.org/10.1017/S0022215111000041CrossRefPubMed

Simas V, Hing W, Furness J, Walsh J, Climstein M (2020) The prevalence and severity of external auditory exostosis in young to quadragenarian-aged warm-water surfers: a preliminary study. Sports Basel Switz. https://doi.org/10.3390/sports8020017CrossRef

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006CrossRefPubMed

Ma L-L, Wang Y-Y, Yang Z-H, Huang D, Weng H, Zeng X-T (2020) Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res 7:7. https://doi.org/10.1186/s40779-020-00238-8CrossRefPubMedPubMedCentral

Umeda Y, Nakajima M, Yoshioka H (1989) Surfer’s ear in Japan. Laryngoscope 99:639–641. https://doi.org/10.1288/00005537-198906000-00012CrossRefPubMed

10.

Chaplin JM, Stewart IA (1998) The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol Allied Sci 23:326–330. https://doi.org/10.1046/j.1365-2273.1998.00151.xCrossRefPubMed

11.

Deleyiannis FW, Cockcroft BD, Pinczower EF (1996) Exostoses of the external auditory canal in Oregon surfers. Am J Otolaryngol 17:303–307. https://doi.org/10.1016/s0196-0709(96)90015-0CrossRefPubMed

12.

Wong BJ, Cervantes W, Doyle KJ, Karamzadeh AM, Boys P, Brauel G et al (1999) Prevalence of external auditory canal exostoses in surfers. Arch Otolaryngol Head Neck Surg 125:969–972. https://doi.org/10.1001/archotol.125.9.969CrossRefPubMed

13.

Hurst W, Bailey M, Hurst B (2004) Prevalence of external auditory canal exostoses in Australian surfboard riders. J Laryngol Otol 118:348–351. https://doi.org/10.1258/002221504323086525CrossRefPubMed

14.

Altuna Mariezkurrena X, Gómez Suárez J, Luqui Albisua I, Vea Orte JC, Algaba GJ (2004) Prevalence of exostoses among surfers of the Basque Coast. Acta Otorrinolaringol Esp 55:364–368. https://doi.org/10.1016/s0001-6519(04)78537-4CrossRefPubMed

15.

Sheard PW, Doherty M (2008) Prevalence and severity of external auditory exostoses in breath-hold divers. J Laryngol Otol 122:1162–1167. https://doi.org/10.1017/S0022215108001850CrossRefPubMed

16.

Nakanishi H, Tono T, Kawano H (2011) Incidence of external auditory canal exostoses in competitive surfers in Japan. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 145:80–85. https://doi.org/10.1177/0194599811402041CrossRef

17.

Alexander V, Lau A, Beaumont E, Hope A (2015) The effects of surfing behaviour on the development of external auditory canal exostosis. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol Head Neck Surg 272:1643–1649. https://doi.org/10.1007/s00405-014-2950-5CrossRef

18.

Lennon P, Murphy C, Fennessy B, Hughes JP (2016) Auditory canal exostoses in Irish surfers. Ir J Med Sci 185:183–187. https://doi.org/10.1007/s11845-015-1265-xCrossRefPubMed

19.

Attlmayr B, Smith IM (2015) Prevalence of “surfer’s ear” in Cornish surfers. J Laryngol Otol 129:440–444. https://doi.org/10.1017/S0022215115000316CrossRefPubMed

20.

Morris S, Martin T, Mccahon D, Bennett S (2016) Awareness and attitudes towards external auditory canal exostosis and its preventability in surfers in the UK: cross-sectional study. J Laryngol Otol 130:628–634. https://doi.org/10.1017/S0022215116008082CrossRefPubMed

21.

Simas V, Hing W, Rathbone E, Pope R, Climstein M (2021) Auditory exostosis in Australian warm water surfers: a cross-sectional study. BMC Sports Sci Med Rehabil 13:52. https://doi.org/10.1186/s13102-021-00281-5CrossRefPubMedPubMedCentral

22.

Lambert C, Marin S, Esvan M, Godey B (2021) Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol Head Neck Surg. https://doi.org/10.1007/s00405-021-06609-8CrossRef

23.

Wegener F, Wegner M, Weiss NM (2022) External auditory exostoses in wind-dependent water sports participants: German wind- and kitesurfers. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol Head Neck Surg 279:2353–2361. https://doi.org/10.1007/s00405-021-06939-7CrossRef

24.

Boyle S, Keane R, Jinih M, McCarthy Deering E, Patil N, Choo M (2022) An awareness and prevalence study of Irish cold-water athletes and external auditory canal exostoses. J Laryngol Otol 136:659–667. https://doi.org/10.1017/S0022215121004369CrossRefPubMed

25.

Van Gilse P (2009) Des observations ulterieures sur la genese des exostoses du conduit externe par l’irritation d’eau froide. Acta Otolaryngol (Stockh) 26:343–352CrossRef

26.

Adams WS (1951) The aetiology of swimmer’s exostoses of the external auditory canals and of associated changes in hearing. J Laryngol Otol 65:232–250 (concl)CrossRefPubMed

27.

Mudry A (2010) In reference to exostoses of the external auditory canal in white-water kayakers. Laryngoscope 120:2130–2131. https://doi.org/10.1002/lary.21038. (author reply 132-133)CrossRefPubMed

28.

Barbon DA, Hegde R, Li S, Abdelbaki A, Bajaj D (2017) Bilateral external auditory exostoses causing conductive hearing loss: a case report and literature review of the surfer’s ear. Cureus 9:e1810. https://doi.org/10.7759/cureus.1810CrossRefPubMedPubMedCentral

29.

DiBartolomeo JR (1979) Exostoses of the external auditory canal. Ann Otol Rhinol Laryngol Suppl 88:2–20. https://doi.org/10.1177/00034894790880s601CrossRefPubMed

30.

Mlynski R, Radeloff A, Brunner K, Hagen R (2008) Exostoses of the external auditory canal. Is the cold water hypothesis valid for patients in continental areas? HNO 56:410–416. https://doi.org/10.1007/s00106-007-1605-xCrossRefPubMed

31.

Sheehy JL (1982) Diffuse exostoses and osteomata of the external auditory canal: a report of 100 operations. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 90:337–342

32.

Mudry A, Hetzler D (2016) Birth and evolution of chiselling and drilling techniques for removing ear canal exostoses. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 37:109–114. https://doi.org/10.1097/MAO.0000000000000919CrossRef

33.

Timofeev I, Notkina N, Smith IM (2004) Exostoses of the external auditory canal: a long-term follow-up study of surgical treatment. Clin Otolaryngol Allied Sci 29:588–594. https://doi.org/10.1111/j.1365-2273.2004.00865.xCrossRefPubMed

34.

House JW, Wilkinson EP (2008) External auditory exostoses: evaluation and treatment. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 138:672–678. https://doi.org/10.1016/j.otohns.2008.01.023CrossRef

35.

Dobie RA, Hemel SV (2004) Basics of sound, the ear, and hearing. Hear. loss determining eligibility soc. secur. benefits. National Academies Press, Washington, DC

36.

King JF, Kinney AC, Iacobellis SF, Alexander TH, Harris JP, Torre P et al (2010) Laterality of exostosis in surfers due to evaporative cooling effect. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 31:345–351. https://doi.org/10.1097/MAO.0b013e3181be6b2dCrossRef

37.

Roossien CC, Hodselmans AP, Heus R, Reneman MF, Verkerke GJ (2021) Evaluation of a wearable non-invasive thermometer for monitoring ear canal temperature during physically demanding (outdoor) work. Int J Environ Res Public Health 18:4896. https://doi.org/10.3390/ijerph18094896CrossRefPubMedPubMedCentral

38.

Shepherd JT, Rusch NJ, Vanhoutte PM (1983) Effect of cold on the blood vessel wall. Gen Pharmacol 14:61–64. https://doi.org/10.1016/0306-3623(83)90064-2CrossRefPubMed

39.

Shohet J, Justeson D, Wilkins A (2023) Transcanal excision of exostoses: large series comparing bone removal methods. Otolaryngol-Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. https://doi.org/10.1002/ohn.334CrossRef

40.

Okumura MMM, Boyadjian CHC, Eggers S (2007) Auditory exostoses as an aquatic activity marker: a comparison of coastal and inland skeletal remains from tropical and subtropical regions of Brazil. Am J Phys Anthropol 132:558–567. https://doi.org/10.1002/ajpa.20544CrossRefPubMed

41.

Trinkaus E, Samsel M, Villotte S (2019) External auditory exostoses among western Eurasian late Middle and Late Pleistocene humans. PLoS ONE 14:e0220464. https://doi.org/10.1371/journal.pone.0220464CrossRefPubMedPubMedCentral

42.

Harrison DF (1962) The relationship of osteomata of the external auditory meatus to swimming. Ann R Coll Surg Engl 31:187–201PubMedPubMedCentral

43.

Simas V, Hing W, Pope R, Climstein M (2020) Australian surfers’ awareness of “surfer’s ear.” BMJ Open Sport Exerc Med 6:e000641. https://doi.org/10.1136/bmjsem-2019-000641CrossRefPubMedPubMedCentral

Title: External auditory exostosis among surfers: a comprehensive and systematic review
Author: Alexandre Vallée
Publication date: 30-09-2023
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 2/2024
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08258-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

External auditory exostosis among surfers: a comprehensive and systematic review

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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