What is the treatment for exostosis of the ear?

Treatment of Exostosis of the Ear

Surgical removal is the definitive treatment for symptomatic exostosis of the ear when medical management fails to control recurrent infections or when significant canal obstruction is present.

Understanding Exostosis

• Exostoses are broad-based hyperostotic lesions that are typically multiple, bilateral, located in the medial ear canal near the eardrum, and associated with prior history of cold-water swimming 1
• These acquired bony growths may severely limit the patency of the ear canal and trap cerumen and keratin debris in the bony canal, preventing adequate visualization of the tympanic membrane 1
• They are distinct from osteomas, which are less common, usually lateral in the bony ear canal, solitary, unilateral, and pedunculated 1

Indications for Treatment

Conservative Management (First-Line)

• Most cases of exostosis are asymptomatic and do not require active intervention 2, 3
• Medical management is appropriate for mild to moderate cases with:
  • Occasional cerumen impaction 1
  • Intermittent external otitis 2, 3
  • Minimal hearing loss 3
• Conservative treatment includes:
  • Regular cerumen removal under direct visualization 1
  • Topical antibiotics for external otitis 2, 3
  • Acidifying ear drops to maintain appropriate ear canal pH 1

Surgical Management (When Conservative Treatment Fails)

• Surgery is indicated when patients experience:
  • Recurrent episodes of external otitis resistant to medical treatment 2, 3
  • Significant canal obstruction (>80%) 3
  • Persistent conductive hearing loss due to canal obstruction 2, 4
  • Need for wider access to the middle ear for other procedures 5

Surgical Approaches

Transcanal Approach

• Preferred method for most cases 2, 3
• Can be performed under local anesthesia as an outpatient procedure 3
• Uses specialized mallet and thin chisel or osteotome for removal 3
• Average healing period is approximately 6 weeks (range 3-10 weeks) 5

Endoscopic Technique

• Newer approach providing superior visualization of the external auditory canal 6
• Offers improved wide-angled views without blind spots 6
• May reduce risk of complications due to better visualization 6

Post-auricular or Endaural Approaches

• Reserved for more extensive cases 3
• May be necessary when transcanal access is limited 2

Potential Complications

• Tympanic membrane perforation (reported in approximately 5-10% of cases) 5, 4
• Temporary or permanent hearing loss 4
• Canal stenosis, particularly in cases with preoperative severe persistent external otitis 4
• Exposure of the temporomandibular joint capsule 5
• Facial nerve injury (rare but serious) 4, 6
• Infection, including rare cases of petrositis 5

Special Considerations

• Surgery should ideally be performed on uninfected ear canals to reduce risk of postoperative stenosis 4
• Preservation of meatal skin without circular incision is recommended to avoid postoperative canal stenosis 4
• Patients with pre-existing sensorineural hearing loss require special attention to avoid additional hearing damage 4
• Careful follow-up is necessary to monitor for complications and ensure complete healing 5

Outcomes

• When properly performed, surgical removal of exostoses has a high success rate 2, 5
• Recurrence of exostoses is rare after complete surgical removal 5
• Most patients experience resolution of symptoms and improved hearing 2, 3
• The majority of complications are minor, but even minor complications can have troublesome consequences 5