Through the Otoscope
Michael J. Rensink, MD, is a member of ENT Associates of San Diego and has been a practicing ENT specialist for more than 35 years.
Osteomas are pearl-like bony growths in the external ear canal. These can be small or large, and have a variety of shapes. The larger growths tend to be problematic because they interfere with the natural aeration and drainage of the external ear, at times trapping water or debris in the canal. This condition is commonly called surfer's ear because most of those who suffer from it are surfers.
These bony growths occur when the ear is exposed to ocean water regularly. Experts believe that the change in temperature created by ocean water moving in and out of the ear canal stimulates bone growth. Luckily, this condition does not occur when the typical patient's ears are exposed to bath or shower water.
One of my patients recently came in with a large white “pearl” visible in the upper portion of his ear canal. (Figure 1.) The growth occludes the canal in this region, and two small white pearls are also present just below the much larger growth. Yet another growth is seen in the lower left portion of the canal. These growths somewhat obscure the ear canal, making it difficult to see the eardrum.
Some patients with surfer's ear are not aware of these growths in their ears. They may come to the office as a result of an ear infection or loss of hearing due to a cerumen impaction. Education is an important part of the treatment plan if the patient is not aware of the condition and gravity of the pathology because the condition will only worsen unless exposure to ocean water is avoided. In addition to managing infections and impactions, practitioners should have the patient obtain well-fitted ear plugs to use when surfing. I also tell the patient that I want to see him periodically to ensure the growths have stopped.
In the left ear of this same patient, a large osteoma was present in the upper portion of the ear canal. The growth has occluded a considerable portion of the canal. (Figure 2.) If you look carefully, you can see that the lower portion of the canal is occluded with ear wax. I removed some wax prior to the photograph, and will remove the remainder after the patient softens the wax with oil. Study this photograph, and notice how water and debris can get trapped deeply in the ear, behind the osteoma.
When this problem is in an advanced stage, as is the case with this patient's left ear, patients tend to experience marked increases in ear infections because the trapped water accelerates fungal and bacterial growth. If this condition progresses and the osteomas become large, preventing proper cleaning of the ear, infections tend to become chronic, and the patient is a candidate for surgery. The goal of the surgery is to remove the bony growth and restore the ear canal to normal function. Needless to say, it is better to prevent continual bony growth and avoid surgery by using ear plugs and ongoing medical management.