You can always try this ... OR ... Come to the Surfer's Academy! (Image Credit: TSJ)

You can always try this … or … come to the Surfer’s Academy! (Image Credit: TSJ)

External Auditory Exostosis/Exostoses, or “Surfer’s Ear”, are generally painless, benign, maladies that do not require surgical intervention. Progressive growth leads to increasing external auditory canal obstruction, conductive hearing loss, and possible frequent episodes of otitis externa (i.e. infection).

Whilst the cause of surfer’s ear, has yet to be conclusively established, prevailing clinical consensus accepts cold water exposure as an initiation factor.

There is even anthropological evidence to support this hypothesis. Kennedy et al.1 showed 30% prevalence (i.e. burden of disease) in populations with known frequent cold water-based activities. Another study examined crania (i.e. skulls) from Northern Chilean coastal dwellers and found coastal residents to have a 30.7%, compared to 2.3% and 0% for valley inhabitants and highlanders respectively2.

Interesting … Right? So Read on…

The scientific and medical community has also delved into this topic. In 2004, Altuna et al.3 looked at the prevalence and severity of surfer’s ear in surfers on the Basque Coast. The study included 41 surfers: 39 male and 2 female, none of which used ear protection whilst surfing. Sixty one percent (61%), or 25 surfers had surfer’s ear, and in all but three cases the findings were bilateral. This contrasts with other reported data focusing on surfers. Prevalence ranging from 38%4, in a sample of 202 surfers, to 80%5 (Study Population: 51 individuals) have been reported. Studies by Wong6 and Chaplin7 have found prevalence levels of 73.5%, and 73%, respectively.

Left: Healthy Ear Canal / Right: Multiple Eccentric Exostoses (Image Credit: SMA)

Left: Healthy Ear Canal / Right: Multiple Eccentric Exostoses (Image Credit: SMA)

The existing evidence points to a higher burden of disease amongst surfers than the general public. Furthermore, increasing prevalence and severity seems to be associated with cumulative years of surfing and intensity of practice. Wong suggests 10 years or more as a plausible boundary, assuming active surfing between 10 and 12 months annually with an average daily surf session of 2-3 hours duration. Whereas, an earlier study by Deleyiannis et al.8, following Oregon and Northern Californian surfers, reported that individuals surfing five (5) years or less were unlikely to develop surfer’s ear unless they surfed greater than 50 sessions/year. Kroon et al.4 showed that those who surfed predominantly in colder waters had a significantly increased risk of surfer’s ear (Odds Ratio: 5.8), and that the number of years surfing increased the risk of developing the condition by 12% per annum.

Dr.Frederique Elffers-Tan (Consultant ENT Surgeon & EASD Member).

Dr. Frederique Elffers-Tan (ENT Specialist)

Want to find out more?

For more on Surfer’s Ear why not come to the Surfer’s Academy. Listen to EASD Surfing Doctor and Consultant Ear Nose Throat (ENT) Surgeon, Dr. Frederique Elffers-Tan, share her knowledge on the Surfer’s Ear and other surfing-related ear issues. Also, check out this informative case study from Surfing Medicine, The Journal of our US counterpart, the Surfer’s Medical Association (SMA).

The European Association of Surfing Doctors (EASD) “Keeping the Surfer Healthy and Safe”.

REGISTER now for the Surfer’s Academy before it’s too late!


  1. Kennedy GE. The relationship between auditory exostoses and coldwater: altitudinal analysis. Am J Phys Anthropol. 1986;71:401-415.
  2. Standen VG, Arriaza BT, Santoro CM. External auditory exostosis in prehistoric Chilean populations. Am J Phys Anthropol.1997;103:119-129.
  3. Altuna Mariezkurrena X, Gómez Suárez J, Luqui Albisua I, Vea Orte JC, Algaba Guimerá J. Prevalence of exostoses among surfers of the Basque Coast. Acta Otorrinolaringol Esp. 2004 Oct;55(8):364-8.
  4. Kroon DF, Lawson ML, Derkay CS, Hoffmann K, Mc Cook J. Surfer´s ear. External auditory exostoses are more prevalent in cold water surfers. Otolaryngol Head Neck Surg.2002;126:499-504.
  5. Umeda Y, Nakajima M. Surfer’s ear in Japan. Laryngoscope.1989;99:639-641.
  6. Wong B, Cervantes W, Doyle KJ, Karamzadeh AM, Boys P, Brauel G, Mushtaq E. Prevalence of External Auditory Canal Exostosis in surfers. Arch Otolaryngol Head Neck Surg 1999;125:969-972.
  7. Chaplin JM, Stewart IA. The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol 1998;23:326-330.
  8. Deleyiannis FW, Cockcroft BD, Pinczower EF. Exostoses of the external auditory canal in Oregon Surfers. Am J Otolaryngol 1996;17:303-307

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