Exostoses of the external auditory canal : Is the
cold water hypothesis valid for patients in continental areas?
HNO.
2007
INTRODUCTION: Exostoses of the
external auditory meatus are benign masses of tympanal bone that can
lead to infections of the external auditory meatus in advanced cases
and then need surgical treatment. Regular irritation of the auditory
meatus by exposure to cold water was implicated in the causation of
exostoses long ago. The present study investigates the cold water
hypothesis in a patient group of continental origin. The surgical
procedures and results are discussed. STUDY DESIGN: Retrospective
study. MATERIALS AND METHODS: We present the epidemiological and
aetiological data and postoperative findings recorded for 144
patients (167 procedures) who underwent surgical removal of
exostoses from the external auditory meatus in the hospital in
Würzburg within 11 years. In attempt to glean further information
about the aetiology, patients were also asked to complete a
questionnaire on participation in water sports and their symptoms
before and since the operation. RESULTS: Most of the patients (94%)
had taken part in water sports for some years, more than 80% of them
several times weekly. The most common indication for surgical
removal was recurrent infection of the external ear. Although 50% of
the patients reported improved hearing, no higher sound threshold
was observed. Reversible complications (ear drum perforation,
tinnitus, opening of mastoid cells) were observed in 18% of the
patients. One patient had a stenosis of the auditory canal caused by
scar tissue. CONCLUSIONS: Surgical removal of exostoses in the
external auditory canal is frequently fraught with controllable
complications. The indications for their surgical removal should be
strictly applied; the presence of exostoses in isolation is not an
acceptable indication for surgery. Removal of exostoses is an
adequate way of avoiding recurrent external ear infections. Improved
hearing can be expected only if the self-cleaning function of the
external auditory meatus is improved.
Auditory
exostoses as an aquatic activity marker: a comparison of coastal and
inland skeletal remains from tropical and subtropical regions of
Brazil.Am
J Phys Anthropol. 2007
Apr;132(4):558-67.
Auditory exostoses are bone masses located in the external auditory
canal. Currently, most researchers agree that the environment
(especially water temperature, but also atmospheric temperature and
wind action) plays a pivotal role in the development of this trait.
This article discusses whether the presence of auditory exostoses
can be used as an aquatic activity marker in bioarchaeological
studies, especially in groups that inhabited tropical and
subtropical regions. We analyzed 676 skeletons (5,000 years BP to
historical times) from 27 coastal and inland native Brazilian
groups. Very low frequencies of auditory exostoses were found in the
inland groups (0.00-0.03), but the expected high frequency of
auditory exostoses in the coastal groups was not always observed
(0.00-0.56). These differences might be explained by the combination
of water and atmospheric temperatures in conjunction with wind
effects. In areas with mild atmospheric temperatures and wind chill
factors, the coastal populations analyzed do not show high
frequencies of auditory exostoses. However, high frequencies of
auditory exostoses develop where cold atmospheric temperatures are
further lowered by strong wind chill. Therefore, the association
between aquatic activities, low atmospheric temperature, and wind
chill is strongly correlated with the presence of auditory exostoses,
but where these environmental factors are mild, the frequencies of
auditory exostoses are not necessarily high. Concluding, auditory
exostoses should be cautiously used as a marker of aquatic activity
in bioarchaeological studies in tropical and subtropical regions,
since these activities do not always result in the presence of this
trait.
Exostosis of the
internal auditory canal in a patient with myotonic dystrophy.
Laryngorhinootologie. 2006
Oct;85(10):755-9.
A
53-year-old patient with myotonic dystrophy presented to our clinic
with progressive bilateral hearing loss. The ENT status and
particularly the otological examination were without pathological
signs. Pure tone audiograms showed a bilateral moderate to severe
sensorineural hearing loss. Routinely performed computed tomography
of the temporal bones revealed the rare picture of exostosis of the
internal auditory canals and the medial surface of the petrous
bones. To our knowledge, this is the first report describing
exostosis of the internal auditory canal in a patient with myotonic
dystrophy, although at present it remains unclear in how far there
is a causal connection between these two pathologies.
Exostoses of
the external auditory canal: a long-term follow-up study of surgical
treatment.Clin
Otolaryngol Allied Sci. 2004
Dec;29(6):588-94.
To determine
the postoperative incidence, extent and recurrence rate of exostoses
of the external auditory canal in a cohort of patients involved in
different water sports. A cross-sectional study of 31 patients (46
ears), with exostoses treated by surgery in the Royal Cornwall
Hospital between 1980 and 1999. A questionnaire was used to obtain
information about the type of water exposure pre- and
postoperatively. The extent of recurrent stenosis was assessed. The
mean postoperative time interval was 10 years (sd = 4.5 years). The
degree of stenosis was assessed as: minimal (<30%) in 42.6%,
moderate (30-60%) in 31% and severe (>60%) in 25% of ears. The Cox
regression model was used to identify factors associated with a
reduction in the recurrence rate of stenosis. The use of ear plugs
was highly significant (P = 0.015), as was the age of the patient at
the time of operation (P = 0.004), i.e. the older the patient, the
faster recurrent disease developed. There was no evidence to show
that either the type or seasonal pattern of water sport activity
influenced recurrence of the disease postoperatively, although
preoperatively, the stenosis was more marked in association with
surfing and sailing. Exostoses developed faster preoperatively in
those who were in the water all year round rather than just the
summer months. Of five patients who stopped water sport activity
completely after surgery, four of them developed significant
recurrent exostoses (>50% stenosis).
Surfer's
ear: external auditory exostoses are more prevalent in cold water
surfers.Otolaryngol
Head Neck Surg. 2002
May;126(5):499-504.
OBJECTIVE:
The study goal was to demonstrate the prevalence and severity of
external auditory exostoses (EAEs) in a population of surfers and to
examine the relationship between these lesions and the length of
time surfed as well as water temperature in which the swimmers
surfed. It was hypothesized that subjects who predominantly surfed
in colder waters had more frequent and more severe exostoses.
METHODS: Two hundred two avid surfers (91% male and 9% female,
median age 17 years) were included in the study. EAEs were graded
based on the extent of external auditory canal patency; grades of
normal (100% patency), mild (66% to 99% patency), and
moderate-severe (<66% patency) were assigned. Otoscopic findings
were correlated with data collected via questionnaires that detailed
surfing habits. RESULTS: There was a 38% overall prevalence of EAEs,
with 69% of lesions graded as mild and 31% graded as
moderate-severe. Professional surfers (odds ratio 3.8) and those
subjects who surfed predominantly in colder waters (odds ratio 5.8)
were found to be at a significantly increased risk for the
development of EAEs. The number of years surfed was also found to be
significant, increasing one's risk for developing an exostosis by
12% per year and for developing more severe lesions by 10% per year.
Individuals who had moderate-severe EAEs were significantly more
likely to be willing to surf in colder waters than were those who
had mild EAEs (odds ratio 4.3). CONCLUSIONS: EAEs are more prevalent
in cold water surfers, and additional years surfing increase one's
risk not only for developing an EAE but also for developing more
severe lesions.
Exostosis of the external auditory canal: a technical note.Otol
Neurotol. 2002 May;23(3):260-1.
OBJECTIVE:
To describe the author's method of managing occlusive exostosis of
the external auditory canal. STUDY DESIGN: Retrospective chart
review. SETTING: Tertiary referral ambulatory otology clinic.
PATIENTS: A case series of patients treated sequentially by the
author over 15 years, all of whom had occlusive external auditory
canal exostoses that could not be treated by medical management.
INTERVENTION: Permeatal surgical removal of the anterior exostosis
only. MAIN OUTCOME MEASURE: Surgical relief of occlusive external
auditory canal disease by restoration of hearing and absence of
infection with persistence of an external auditory canal and no
symptoms of recurrence. RESULTS: A total of 8 men were treated by
anterior exostosis removal. Follow-up continued on these patients
for a period of 5 to 15 years after the operation, and none showed
any evidence of recurrence or tendency to narrowing of the deep ear
canal. One patient incurred a tympanic membrane perforation at
escostosis surgery that was repaired during the operation.
CONCLUSION: Anterior exostosis removal by a permeatal route is a
safe, rapid, and effective method of relieving patients of occlusive
external auditory canal exostosis. By leaving the posterior
exostosis intact, patients are not put at risk for injury to the
facial nerve, chorda tympani nerve, or ossicles. When the deep ear
canal is drilled blind, there are no landmarks to indicate the true
path of the external canal.
Results and
extraordinary complications of surgery for exostoses of the external
auditory canal.HNO.2000 Feb;48(2):125-8.
We present a
retrospective study on 22 operations of exostosis of the external
auditory canal in 20 patients. 8 patients were passionated by water
sports. The most frequent indication for surgery (13 operations) was
recurrent external otitis or ceruminal obstruction. In 7 cases the
need for a wider access to the middle ear indicated surgery. Surgery
was usually performed as an outpatient procedure, maximum
hospitalization was 3 days. The mean healing period was 6 (3-10)
weeks. Mean follow up was 43 (3-110) months. There were no severe
intraoperative complications such as facial paresis, lesions of the
ossicles or of the inner ear. As intraoperative complications we
found 2 perforations of the tympanic membrane, 2 expositions of the
capsule of the mandibular joint, one of which was followed by
chronic pain. As postoperative complications we found an early soft
tissue stenosis of the external auditory canal and one late soft
tissue stenosis which recurred after revision surgery. No recurrence
of exostosis was seen. We describe an up to now unknown
complication: the appearance of bilateral petrositis caused by
staphylococcus epidermidis after bilateral surgery in an otherwise
healthy patient. This study confirms that severe complications are
rare, minor ones however relatively common. And that also minor
complications may have a troublesome follow. Therefore and because
of the potential of severe complications indication for surgery must
be made cautiously and risks of the operation must not be
underestimated.
Prevalence of external auditory canal exostoses in surfers.Arch
Otolaryngol Head Neck Surg. 1999
Sep;125(9):969-72.
OBJECTIVE:
To determine (1) the prevalence of external auditory exostoses in a
population of surfers and (2) the relationship between the length of
time spent surfing and the prevalence, severity, and location of the
exostoses. DESIGN: Cross-sectional epidemiological study. SETTING:
General community. PATIENTS: Three hundred seven avid surfers (93.5%
males and 6.5% females; age distributions: 11.2% were < or =20,
67.9% were 21 to 40, 17.5% were 41 to 50, and 3.3% were >50 years).
MAIN OUTCOME MEASURES: Questionnaires focusing on surfing habits
(number of years, geographic region, and number of days per year of
surfing) were correlated with otoscopic findings. A simple grading
system was devised, based on the degree of external auditory canal
stenosis. Grades of normal, mild, moderate, and severe corresponded
to 100%, 99% to 66%, 65% to 33%, and less than 33% effective patent
surface area, respectively. RESULTS: There was a 73.5% overall
prevalence of external auditory exostoses and a 19.2% overall
prevalence of osteomas in the group studied. Of 441 ears with
exostoses, 54.2% were mild, 23.6% were moderate, and 22.2% were
severe. Of individuals who had surfed for 10 years or less, 44.7%
had normal ear canals and only 6% had severely obstructed auditory
canals. In comparison, in the group that had surfed for longer than
20 years, only 9.1% had normal auditory canals and 16.2% were
severely affected. Of surfers with no exostoses, 61.1% had surfed
for 10 years or less. In contrast, of surfers with severe exostoses,
82.4% had surfed for more than 10 years. Finally, the lesions seemed
to affect all external auditory canal quadrants equally. CONCLUSION:
A positive association exists between the amount of time individuals
spend surfing and the presence and severity of exostoses of the
external auditory canal.
The
prevalence of exostoses in the external auditory meatus of
surfers.Clin
Otolaryngol Allied Sci. 1998
Aug;23(4):326-30.
Fifty-four
surfers and 38 surf life savers were examined and questioned in
order to determine the prevalence of exostoses. Seventy-three per
cent had evidence of body exostoses in the external auditory meatus.
Forty per cent had their ear canals narrowed by 50% or more. The
relationship between the number of years spent surfing or life
saving and the extent of canal stenosis was highly significant (P <
0.00001). Left and right ears were affected equally in this series
and the obstruction appears to begin after approximately 7 years and
is further aggravated by continued surfing. Over 90% of subjects who
had participated for longer than 10 years had some evidence of
exostoses. There was no significant association between the number
of days per year or the number of hours per day spent surfing and
the development of surfer's ear in this sample. Those who
participated in their water sport over winter had significantly more
exostoses than those who did not (P < 0.0001). Those who lived in
the South Island (colder water) had more surfer's ear than those in
the North Island (warmer water).
External ear
canal exostosis and aquatic sports.ORL
J Otorhinolaryngol Relat Spec.
1984;46(3):159-64
Many
reports suppose that the development of aural exostosis depends on
the action of an irritative stimulus like frequent and repeated cold
water contact. This survey studies the incidence of this lesion in a
group of 433 athletes practicing aquatic sports on a highly
competitive level. Among these, water activities like sailing and
deep-sea diving, which up to now were never considered, were also
studied. 32 exostoses were found to affect 12 subjects monolaterally
and 20 subjects bilaterally. Not one of a control group of 476
athletes was found to be affected by aural exostosis. For each
athlete in this study the following parameters are considered: age
and sex, type of sport, total amount of hours spent in water
contact, aural pathology history and otoscopic findings. The authors
suggest the existence of facilitating factors other than total water
contact time, as shown by the absence of a precise correlation
between this parameter and the presence of the aural hyperostotic
lesion.
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