Auditory Exostoses Research Articles

Evaluating external auditory exostosis severity using ImageJ: A clinical method applied to archaeological remains

Evaluating external auditory exostosis severity using ImageJ: A clinical method applied to archaeological remains

Canalplasty using osteotome in a unilateral ear auditory exostoses (EAE) without cold water exposure: a case report

Background: Ear auditory exostoses (EAE) or surfer’s ear is a slow benign bony growth within the external auditory canal (EAC). The exact etiology of EAE remains unclear but it is commonly associated with chronic exposure to cold water or wind. The technique of surgery can be transcanal, endaural, or postauricular approach, based on the surgeon's experience. To our knowledge, this is the first documented report of a patient with recurrent EAE without cold water exposure. The purpose of this study is to present a rare case report about a woman with unilateral EAE without cold water exposure with transcanal osteotome surgical approach. Case presentation: A 29-years-old woman was referred to the Ear, Nose, and Throat Department, West Nusa Tenggara General Hospital, Mataram, Indonesia with left ear fullness since one week ago. The patient was told that she had a lump within the ear canal since 2013 but she had no symptoms. There was no history of recurrent ear infection or participating in water activities. Otoscopy of the left ear revealed a lump rising from EAC that covers 90% of EAC. We could not visualize the left tympanic membrane. The CT scan of her temporal bone demonstrated a hard density mass in the left EAC. The patient was done surgically with a transcanal approach. Indication for this patient was the occlusion of more than 80% of EAC. Transcanal with osteotome was chosen because of its less complication than others. Conclusion: It is unusual that our patient developed EAE without the usual precipitating factor. The surgery was done with a transcanal approach with an osteotome to prevent complications postoperative. Future experimental studies should be performed.

What do windsurfers and kitesurfers in Germany know about surfer's ear and how is it influenced by protective measures?

This study investigated the frequency of ear canal protection use and looked at its influence on external auditory exostosis severity and knowledge about external auditory exostosis among windsurfers and kitesurfers on the German coast. This retrospective cross-sectional study interviewed 130 windsurfers and kitesurfers along the German coast on knowledge of external auditory exostosis, exposure time, use of neoprene hoods and earplugs, and otological complaints. Participants underwent bilateral video-otoscopic examination. Knowledge of external auditory exostosis was 'good' or 'excellent' in 78 of 130 (60 per cent) individuals and 'poor' or non-existent in 52 of 130 (40 per cent) individuals. Knowledge was positively correlated with hours of exposure, otological complaints and frequency of ear canal protection use. A significant negative influence of neoprene hood use on external auditory exostosis severity was shown. The positive effect of external auditory exostosis knowledge on the frequency of ear canal protection and the reduction of external auditory exostosis risk implies a need for health education on this topic.

Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods.

External auditory exostosis (EAE) is a condition of progressive temporal bone growth into the external auditory canal most commonly from repeat cold water and wind exposure. Several tools have been utilized for EAE excision with varying implications for intra- and postoperative complications. However, comparisons of osteotome and microdrill are made difficult due to the few published cases and intervariability between surgeons. Furthermore, evidence is needed to analyze the safety of novel supplemental tools such as the piezoelectric bone-cutting device. Retrospective chart review. Medical clinic and surgery center. A total of 413 subjects representing 472 earsmet the inclusion criteria. Of which 159 ears were operated on using osteotome alone (OA), 271 using osteotome with a drill (OD), and 42 with osteotome with piezoelectric (OP). Charts were analyzed for the most reported intraoperative complications and postoperative symptoms and complications. There were no significant differences in the rate of tympanic membrane perforations nor in total intraoperative complications between OA, OD, or OP. The OD group contained the only nonperforation intraoperative event. OA had the lowest or near lowest incidence of all symptoms analyzed. OA showed a significantly lower incidence of tinnitus when compared to OD and OP. We found that OA performed the best, though not statistically significant in most measures, with regard to mitigating rates of complications postsurgery. Our findings suggest OA provides lower risk intraoperatively and postoperatively for patients undergoing transcanal exostosis excision.

Living on an island. Cultural change, chronology, and climatic factors in the relationship with the sea among canarian-amazigh populations on Gran Canaria (Canary Islands)

To understand the relationship between past peoples and the sea in a context of oceanic islands, just as in the case of other cultural behaviours, it is necessary to consider many more factors than the mere proximity to the coast. Traditions, ways of life, sailing ability and knowledge, diet, and so on, determine the way in which this relationship is expressed. This paper addresses this matter through the study of external auditory exostosis (EAE) among the aboriginal population of Gran Canaria. The analysis has been completed by contrasting this bioanthropological marker with such other variables as chronology, territory, social dynamics and environmental changes. The study examined a large sample (MNI = 637) from all over the island and a time interval of more than 1200 years, practically the whole pre-Hispanic period. EAE is present in 17.1% of the total population analysed, with no statistically significant differences between males and females. This high prevalence is even more evident when considering its notable incidence among coastal communities and its chronological concentration, between the 13th and 15th centuries, that is, the last 300 years of the historical sequence considered. On balance, the results indicate relevant variation in the relationship that these populations had with the sea in accordance with the historical processes and social changes that took place over more than a millennium.

An awareness and prevalence study of Irish cold-water athletes and external auditory canal exostoses.

This study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes. An online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures. Of the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis. The majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.

Cover Image

The cover image is based on the Research Article External auditory exostoses, repetitive aquatic activity and increasing social complexity in Chalcolithic Cyprus: Specialists of the sea? by Kirsi O. Lorentz and Bianca Casa., https://doi.org/10.1002/oa.2977.

External auditory exostoses in wind-dependent water sports participants: German wind- and kitesurfers

PurposeCold water and wind are known to cause exostoses of the external auditory canal. Different prevalences in different sports have been described in the literature. The aim of this study was to investigate the prevalence of external auditory exostosis (EAE) and EAE severity in coastal German wind- and kitesurfers who are exposed to cold water and strong winds. Furthermore, influencing factors such as the total exposure time and frequency of activity as well as the correlations between symptoms and the severity of EAE were investigated.MethodsIn this retrospective cross-sectional study, German non-professional wind- and kitesurfers along the North and Baltic Sea coasts were recruited between September 2020 and November 2020. Each participant was interviewed about exposure time and otological symptoms and underwent bilateral video otoscopic examination to determine EAE severity.ResultsA total of 241 ears from 130 subjects were analysed. The prevalence of EAE was 75.1%. In 19.9% of the participants, severe EAE was found. Exposure time and the frequency of activity had significant effects on the severity of EAE. Compared to surfers, EAE growth seems to progress faster in wind- and kitesurfers. The number of symptoms requiring medical treatment increased when two-thirds of the external auditory canal was obstructed.ConclusionThe prevalence of EAE in wind- and kitesurfers is high. Total exposure time and the frequency of activity influence EAE growth. EAE growth occurs faster in wind- and kitesurfers than in surfers. The additional influence of wind and the evaporative cooling of the EAC are thought to be responsible. The results of this study should increase awareness of the dynamics of EAE among ENT specialists and improve patient counselling.

Auditory exostosis in Australian warm water surfers: a cross-sectional study

BackgroundSurfing is a popular sport in Australia, accounting for nearly 10% of the population. External auditory exostosis (EAE), also referred to as surfer’s ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19 °C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80%.However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19 °C. With mean water temperature ranging from 19 °C to 28 °C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers.MethodsEligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy.ResultsA total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment.ConclusionTo the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 °C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.

External auditory exostoses, repetitive aquatic activity and increasing social complexity in Chalcolithic Cyprus: Specialists of the sea?

AbstractExternal auditory exostoses (EAEs) are dense osseous hyperostoses that protrude into the external auditory canal and are associated with repetitive aquatic activity. Clinically, the aetiology of EAEs is attributed to prolonged exposure to cold water through activities including swimming, surfing, diving, kayaking and sailing. The prevalence and distribution of EAEs within a particular archaeological context informs on human–environment interactions, activity and behavioural differences between the sexes, habitual aquatic activity (e.g., fishing, diving, swimming, bathing, seafaring, littoral zone resource procurement), marine and aquatic resource exploitation and subsistence patterns. This study aims to assess the prevalence of EAEs within a prominent Chalcolithic skeletal assemblage from Souskiou‐Laona, in southwestern Cyprus. Sixty‐five auditory canals were examined macroscopically and microscopically to confirm the presence or absence of EAEs. Five adult individuals present EAEs (right auditory canals; left ear canals not sufficiently preserved) with a prevalence of 15.1% of all sufficiently preserved right ear canals (33). EAE prevalence is 25% in males and 14.2% in females. Earlier burials on the site, represented by bonestack (commingled) crania, display EAEs at 14.8% prevalence, whereas the last burials (articulated skeletons) show a prevalence of 16.7%. Malacological evidence from Souskiou‐Laona cemetery attests marine resource procurement, including activity at the littoral zone. The EAEs at Souskiou‐Laona likely reflect the diachronic exploitation of marine resources at the south coast of Cyprus from the foundation of the cemetery to the latest burials before abandonment of the site. Both males and females participated in these repetitive aquatic activities. The differential expression of EAEs in the population as a whole, and the different prevalences between males and females, may be interpreted in the context of increasing specialisation and social complexity during the Chalcolithic, consistent with the development of other specialised, standardised and gender‐differential activities during this time period.

Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears.

The aim of the study was to investigate the efficacy of ear protection (earplug and surf hood) in preventing the development of external auditory exostosis (EAE) in surfers. We performed a prospective observational study. Volunteer surfers were recruited from June 2016 to October 2017 on the Brittany coast in France. Each participant filled in a questionnaire and underwent otoscopic digitalized photography to establish the degree of external ear obstruction by two different practitioners. The correlation between the percentage of external ear obstruction and the time spent in water with or without protection was evaluated. Risk factors of EAE were assessed. Two hundred and forty-two ears were analysed. The incidence of EAE was 89.96% with an average rate of obstruction of 37.65%. Risk factors for EAE were male sex (p = 0.0005), number of years practicing surf (p < 0.0001) and symptoms of ear obstruction (p = 0.0358). A significant correlation was found between EAE severity and number of hours spent in water without any protection (earplugs or surf hood) (p < 0.0001). No correlation was found between EAE severity and time spent in water with earplugs (p = 0.6711) but a correlation was identified between obstruction and time spent in water with surf hood (p = 0.0358). Wearing earplugs is an effective way to prevent EAE in surfers unlike surf hood.

External auditory exostoses and early Neolithic aquatic resource procurement in Cyprus: Results from Cypro-PPNB Kissonerga-Mylouthkia in regional context

ObjectiveThis research is designed to evaluate the occurrence of external auditory exostoses (EAEs) in skeletal remains from the oldest known water wells in the world (Kissonerga-Mylouthkia, Cyprus, 8,200-7,200 BCE). MaterialsSix individuals (MNI = 6), five fragmentary temporalia, two preserved auditory canals. MethodsMacroscopic and microscopic (up to x30) observation, with illumination; presence, type, side, severity, occlusion, number, and position of bony growths recorded. ResultsBony growths within two auditory canals were discovered. Differential diagnosis includes osteomata and external auditory exostoses, with the latter consistent with the bony growths (Grade 1 EAEs, two adult males, one with single, another with two EAEs). ConclusionsThe emergence of the Neolithic in Southwest Asia is thought to involve increases in dietary breadth among foraging societies (Broad-Spectrum Revolution). EAEs likely indicate maritime activity in this context, given the lack of freshwater bodies, and zooarchaeological evidence points to dietary and other uses of maritime organisms. SignificanceThis EAE evidence is the oldest known in maritime contexts in Eastern Mediterranean and the Middle East, and first in Cyprus. It contributes towards understanding the initial colonization events by Neolithic farming communities in the 9th millennium BC, and the emergence of broad-spectrum economies at the dawn of the Neolithic in Southwest Asia, crucial for re-considerations of paradigms on the transition to the Neolithic way of life in the Near East. LimitationsOnly a few skeletal remains from these prehistoric contexts were available for observation. Suggestions for further researchFurther intensive review of Cypriot skeletal collections for EAEs is advised.

New Insights into Activity-Related Functional Bone Adaptations and Alterations in Neolithic Liguria (Northwestern Italy)

This study offers a combined analysis of longbone mechanical properties (cross-sectional geometry, CSG), upper-limb enthesopathies (entheseal changes, ECs), and external auditory exostoses (EAEs) among Neolithic people from Liguria (Italy). Previous CSG studies have suggested a high degree of mobility in mountainous terrain and sexual dimorphism in the upper limbs, with males being more oriented toward unimanual activities and females performing strenuous bimanual tasks. The aims of the study were to: 1) increase the sample size of the CSG analysis via the acquisition of surface 3D models, 2) provide a solid chronological framework through direct dating in order to allow for subsampling of individuals dated to the Impresso-Cardial Complex (ICC, c. 5800–5000 BCE) and the Square-Mouthed Pottery culture (c. 5000–4300 BCE), 3) integrate the results of CSG analysis with information on ECs of the humeral epicondyles, and 4) assess possible marine activities through analysis of EAEs. Results from the CSG analysis confirmed those of previous studies, with no significant diachronic change. ECs in the humeral medial epicondyle parallelled CSG adaptations: males tended to display more changes, especially unilaterally. Only one individual from the ICC period showed bilateral EAE, suggesting that marine activities were not prevalent. This study adds to our knowledge on activity patterns in the Neolithic in Liguria, and shows that integrating structural adaptations with information from specific entheseal alterations and exostoses can improve reconstructions of past habitual activities.

The Prevalence and Severity of External Auditory Exostosis in Young to Quadragenarian-Aged Warm-Water Surfers: A Preliminary Study.

External auditory exostosis (EAE) has previously only been shown to occur in cold water surfers. We assessed young surfers living and surfing in Queensland, Australia, for EAE in water temp ranges from 20.6 °C (69.1 °F, Winter) to 28.2 °C (82.8 °F, Summer). All participants underwent a bilateral otoscopic examination to assess the presence and severity of EAE. A total of 23 surfers participated with a mean age of 35.4 years (8.3 years) and a mean surfing experience of 20.0 years (9.9 years). Nearly two-thirds of participants (n = 14, 60.9%) had regular otological symptoms, most commonly water trapping (n = 13, 56.5%), pain (n = 8, 34.8%), and hearing loss (n = 6, 26.1%). Only 8.7% (n = 2) of all surfers reported regular use of protective equipment (e.g., earplugs) on a regular basis. The overall prevalence of exostosis was 69.6% (n = 16), and the majority (n = 12, 80.0%) demonstrated bilateral lesions of a mild grade (<33% obstruction of the external auditory canal). This is the first study assessing EAE in young surfers exposed to only warm waters (above 20.6 °C). The prevalence of EAE in this study highlights that EAE is not restricted to cold water conditions, as previously believed. Warm water surfing enthusiasts should be screened on a regular basis by their general medical practitioner and utilize prevention strategies such as earplugs to minimize exposure to EAE development.

Australian surfers’ awareness of ‘surfer’s ear’

ObjectivesTo assess awareness of external auditory exostosis (EAE) among Australian surfers.MethodsThis is a cross-sectional observational study, assessing professional and recreational Australian surfers. Currently, active surfers over 18 years of age,...

A revision of the conductive hearing loss in Cranium 4 from the Middle Pleistocene site of Sima de los Huesos (Burgos, Spain)

Pathological conditions have been previously documented in the Middle Pleistocene Sima de los Huesos hominins from northern Spain, and several of these have clear behavioral implications. Within this fossil assemblage, Cranium 4 shows bilateral external auditory exostoses which have been preliminarily interpreted as causing a significant hearing loss in this individual. If confirmed, this would be the oldest recorded case of deafness in human history and could have important implications for the antiquity of this condition, as well as social interactions. To further investigate this case, the current study presents 3D reconstructions of the entire outer and middle ear, based on computed tomography scans of both temporal bones in Cranium 4. We established the degree of stenosis in both external auditory canals, showing that in both cases the degree of stenosis is less than 52% of the original cross-sectional area of each canal. Based on clinical studies in living humans, the buildup of wax due to the degree of stenosis in Cranium 4 is unlikely to have caused frequent external ear infections. In addition, we estimated the pattern of sound power transmission up to 5 kHz in both ears relying on a comprehensive model developed in the bioengineering literature and which has been applied previously to the Sima de los Huesos hominins. The model was modified to account for the peculiar shape of the pathological external ear canals in Cranium 4. The results show that this pathology had little to no influence on the sound power transmission in this individual. Thus, we conclude that the exostoses present in both ears of Cranium 4 did not significantly affect their hearing.

Reduction of cicatricial stenosis after canalplasty for auditory exostoses.

Canalplasty for auditory exostoses is reserved for symptomatic patients. This study reviewed the outcomes of our technique regarding cicatricial stenosis. A chart review was conducted on patients undergoing canalplasty for auditory exostoses between 2002 and 2017. The surgical technique is described. The study comprised 43 adults (50 operated ears). Exostoses were bilateral in 40 cases (94 per cent) and occlusive in 33 (66 per cent). After drilling, the external auditory meatus was covered with a graft in 34 cases (68 per cent) and a silicone sheet was used in 32 (64 per cent). Cicatricial stenosis appeared in eight cases (16 per cent). Skin grafts were not used in six of these eight cases (p < 0.04), and silicone sheets were used only in one of these eight (p < 0.01). Canalplasty is challenging because of its potential complications. Our data showed that the use of skin grafts and silicone sheets to cover the bared external auditory meatus was associated with a lower rate of cicatricial stenosis.

External auditory exostoses among western Eurasian late Middle and Late Pleistocene humans.

External auditory exostoses (EAE) have been noted among the Neandertals and a few other Pleistocene humans, but until recently they have been discussed primary as minor pathological lesions with possible auditory consequences. An assessment of available western Eurasian late Middle and Late Pleistocene human temporal bones with sufficiently preserved auditory canals (n = 77) provides modest levels of EAE among late Middle Pleistocene archaic humans (≈20%) and early modern humans (Middle Paleolithic: ≈25%; Early/Mid Upper Paleolithic: 20.8%; Late Upper Paleolithic: 9.5%). The Neandertals, however, exhibit an exceptionally high level of EAE (56.5%; 47.8% if two anomalous cases are considered normal). The levels of EAE for the early modern humans are well within recent human ranges of variation, frequencies which are low for equatorial inland and high latitude samples but occasionally higher elsewhere. The Early/Mid Upper Paleolithic frequency is nonetheless high for a high latitude sample under interpleniglacial conditions. Given the strong etiological and environmental associations of EAE development with exposure to cold water and/or damp wind chill, the high frequency of EAE among the Neandertals implies frequent aquatic resource exploitation, more frequent than the archeological and stable isotopic evidence for Middle Paleolithic/Neandertal littoral and freshwater resource foraging implies. As such, the Neandertal data parallel a similar pattern evident in eastern Eurasian archaic humans. Yet, factors in addition to cold water/wind exposure may well have contributed to their high EAE frequencies.

Lifetime prevalence of exostoses in New Zealand surfers.

INTRODUCTION External auditory exostosis (EAE) is a benign, irreversible bony outgrowth that arises from the temporal bone. EAE projects into the external ear canal, potentially causing recurrent otitis externa and conductive hearing loss. AIM To determine lifetime prevalence of EAE in New Zealand (NZ) surfers. METHODS This study used an online national survey. RESULTS Respondents were 1376 NZ surfers (recreational = 868, competitive = 508). Mean surfing experience was 16.2 years. Most self-classified as advanced surfers (36.5%), followed by intermediate (30.2%), expert (20.1%) and beginner (13.2%). Surfers reported an average of 214.2 h surfing (28.6% during winter) for the previous year. Overall lifetime prevalence of EAE was 28.9% (32.1% male, 14.6% female; P < 0.001), with the highest proportion of EAE was observed bilaterally (21.3%). Competitive surfers reported a significantly (P < 0.001) higher lifetime prevalence of EAE than recreational surfers (45.3% vs. 19.2%). A significantly higher (P < 0.001) lifetime prevalence of EAE was identified as skill level increased (7.1% in beginners to 55.6% in experts) and a two-fold increase (P < 0.001) of EAE in the highest (vs. lowest) quartile of surfing exposure. Neither winter surfing exposure nor which Island surfed were associated with EAE prevalence. DISCUSSION Although not as prevalent as in previous NZ research using otologic examinations, this study indicated that almost one-third of NZ surfers reported having had a diagnosis of EAE. Regular general practitioner otologic assessment and advice on appropriate prevention strategies for patients who surf may help prevent large lesions, recurrent ear infections and progressive hearing loss.

Cold-water diving in the tropics? External auditory exostoses among the pre-Columbian inhabitants of Panama.

The appearance of external auditory exostoses archaeologically has been attributed to aquatic activities in middle latitudes. However, recent clinical research implicates low sea surface temperatures, especially below a threshold of 19°C, as a stronger predictor of ear exostosis development than latitude. Here, we examine the frequency of external auditory exostoses in human remains from nine pre-Columbian archaeological sites in Panama, representing individuals from a warm, tropical region. External auditory exostoses were recorded as present when an abnormal bony growth was observed macroscopically within the ear canal. The presence of exostoses was compared by right and left side, geographical region, sex, and degree of stenosis. A total of 125 adult individuals made up the observable sample analyzed in this study. Exostoses were observed in seven males and one female. All individuals affected by this pathology were excavated from mortuary contexts along the Gulf of Panama-a region characterized by intense cold water upwelling in the dry season. This study suggests that external auditory exostoses in pre-Columbian Panama affected individuals involved in habitual aquatic activities in the cold, upwelled waters of the Gulf of Panama. These activities appear to be almost exclusively dominated by male individuals. Ethnohistorical and archaeological records point to marine shell resource acquisition by deep-water diving as the activity driving exostosis development in pre-Columbian Panama.