What are the symptoms and treatment options for exostoses (bony growths) of the ear?

From the Guidelines

Exostoses of the ear should be treated with surgical removal (canalplasty) if they cause symptoms like recurrent ear infections or hearing loss, as this approach has been shown to improve outcomes in terms of morbidity, mortality, and quality of life. When considering treatment options for exostoses of the ear, it is essential to prioritize the patient's overall well-being and take into account the potential risks and benefits of each approach. In patients with abnormal otologic findings, such as obstructing exostoses, manual removal of cerumen is often preferred 1. This approach allows for direct visualization of the external auditory canal and does not expose the ear to moisture, reducing the risk of complications. The use of specialized equipment, such as a binocular microscope, can provide stereoscopic magnification and improve the accuracy of the procedure 1. However, in cases where surgical removal is necessary, it is crucial to follow proper post-operative care, including avoiding water exposure for 4-6 weeks and using antibiotic ear drops for 7-10 days, to minimize the risk of infection and promote healing. Prevention is also key, particularly for individuals who engage in activities that involve repeated exposure to cold water, such as surfing or swimming, who should use custom-fitted earplugs or neoprene headbands to reduce the risk of developing exostoses 1. By prioritizing the patient's overall health and well-being, healthcare providers can make informed decisions about the best course of treatment for exostoses of the ear, taking into account the latest evidence and guidelines. Some key points to consider when treating exostoses of the ear include:

• The importance of proper diagnosis and evaluation to determine the best course of treatment
• The use of manual removal of cerumen in patients with abnormal otologic findings
• The need for specialized equipment and expertise in performing surgical removal
• The importance of post-operative care and follow-up to minimize the risk of complications
• The role of prevention in reducing the risk of developing exostoses, particularly in individuals who engage in high-risk activities.

From the Research

Definition and Causes of Exostoses

• Exostoses of the external auditory canal are benign bony tumours that are very common in individuals who frequently participate in aquatic activities, particularly in cold water 2, 3, 4.
• They can occur in patients living in coastal communities with a history of cold-water aquatic activities such as ocean surfing and swimming 3.

Symptoms and Treatment

• Although most cases of exostoses are asymptomatic, patients with more severe exostoses can experience recurrent episodes of external otitis and related conductive hearing loss 2, 3.
• Medical treatment, such as aspiration and antibiotic drops, can resolve symptoms in most cases 2, 3.
• Patients with more severe canal stenosis or those who are resistant to medical treatment may require surgical removal of the exostoses 2, 3, 5.
• Surgical techniques for removing exostoses include transmeatal removal with a specialized mallet and thin chisel under local anesthesia 3, and the use of a piezo saw 4.

Surgical Complications and Considerations

• Complications of surgical removal of external auditory canal exostoses can include tympanic membrane perforation, postoperative hearing loss, canal stenosis, and facial nerve injuries 5.
• Exostosis surgery should be reserved for uninfected ear canals, and meatal skin preservation without circular meatal flap incision is recommended to avoid postoperative canal stenosis 5.
• In cases of preexisting sensorineural hearing loss, attention should be focused on intraoperative noise reduction by tympanic membrane protection and pauses of noise exposition 5.

Internal Auditory Canal Exostoses

• Exostoses can also occur in the internal auditory canal (IAC), although they are rare and difficult to distinguish from osteomas in this location 6.
• Radiologic and histologic criteria can be used to differentiate exostoses from osteomas of the IAC, including the presence of bone marrow in high-resolution computed tomography scans or fibrovascular channels on histologic analysis 6.
• Management of IAC exostoses and osteomas is customized based on patient symptoms, and may involve surgical removal or observation 6.