Differential Diagnosis for Bony Growths in Ear Canal with History of Cold Water Swimming

• Single most likely diagnosis:
  • Exostoses (also known as surfer's ear): This condition is characterized by the growth of bony tumors in the ear canal, often associated with prolonged exposure to cold water, making it highly likely given the patient's history of cold water swimming.
• Other Likely diagnoses:
  • Osteomas: These are benign bony growths that can occur in the ear canal, though they are less commonly associated with cold water exposure compared to exostoses.
  • Cerumen impaction or other benign ear canal conditions: While not bony growths, these conditions can cause similar symptoms and should be considered in the differential diagnosis.
• Do Not Miss diagnoses:
  • Malignant otolaryngologic tumors: Although rare, it's crucial to rule out malignant tumors such as squamous cell carcinoma or other cancers that could present with similar symptoms, as missing these diagnoses could be fatal.
  • Invasive fungal infections: In immunocompromised patients, fungal infections can invade the ear canal and surrounding bone, leading to destructive lesions that might be mistaken for bony growths.
• Rare diagnoses:
  • Fibrous dysplasia: A rare condition where normal bone is replaced with fibrous tissue, potentially leading to bony growths or deformities in the ear canal.
  • Osteochondromas: Benign cartilage-capped bony projections that can occur near the growth plates of bones but are rare in the ear canal.
  • Cholesteatomas: Abnormal skin growths in the middle ear behind the eardrum, which can be destructive and might be considered if the bony growths are causing significant damage or if there are symptoms suggesting middle ear involvement.