Surfer's Ear: Causes, Symptoms, Prevention & Treatment
Surfer's ear is the everyday name for external auditory canal exostoses (EAE) — bony lumps that grow inside your ear canal after years of cold water and wind exposure. The growths are benign, but they narrow the canal, trap water and wax, and can eventually cause infections and hearing loss. This guide explains what causes it, how to spot it early, how to prevent it, and what surgery involves if prevention comes too late.
What Is Surfer's Ear?
Surfer's Ear: Causes, Symptoms, Prevention & Treatment - What Is Surfer's Ear?.
Surfer's ear is an exostosis: a non-cancerous overgrowth of the tympanic bone that surrounds the ear canal. Unlike a tumor, it is not diseased tissue — it is your body laying down new bone as a defensive response to repeated cold-water irritation.
A normal ear canal is roughly 7 mm wide with a volume of about 0.8 ml (about one-sixth of a teaspoon). As exostoses accumulate, that passage narrows. People usually seek medical help once it constricts to 0.5–2 mm, because that is when hearing starts to feel muffled and water stops draining.
Key facts at a glance:
- Benign but progressive — growths do not spread, but they do keep enlarging with continued exposure.
- Usually bilateral — most patients develop exostoses in both ears, though one side is often worse.
- Named for surfers, not limited to them — kayakers, swimmers, divers, sailors, windsurfers, and jet skiers are all at risk.
What Causes Surfer's Ear?
Surfer's Ear: Causes, Symptoms, Prevention & Treatment - What Causes Surfer's Ear?.
The trigger is repeated exposure to cold water and wind, not surfing itself. Cold water flowing into the ear canal cools the bone, and the body responds by depositing new bone. Wind accelerates the effect through evaporative cooling.
Stanford Health Care notes that water colder than 66°F (about 19°C) is associated with more frequent exostosis development. That is why cold-water surf regions show the highest rates — and why wetsuit technology has made things worse, not better: better suits let people stay in frigid water far longer than they could before.
One ear is often more affected than the other. Researchers attribute this to the prevailing wind direction at a given break, or simply to whichever side habitually hits the water first.
Who Is at Risk?
Surfer's Ear: Causes, Symptoms, Prevention & Treatment - Who Is at Risk?.
The short answer: anyone who spends regular time in cold, wet, windy conditions without ear protection.
| Activity | Relative risk |
|---|---|
| Cold-water surfing | Very high |
| Kayaking (especially white-water) | High |
| Windsurfing, kitesurfing, sailing | High |
| Diving, jet skiing, open-water swimming | Moderate to high |
| Warm-water surfing | Lower but not zero |
The prevalence numbers are striking. A 2023 study found surfer's ear prevalence among surfers as high as 73%, with rates climbing in colder climates. A separate survey of surfers in Ireland and California found 75.7% showed some degree of surfer's ear, rising to 84% among those who had surfed more than 10 years — and half of those long-term surfers had severe canal closure.
Age patterns matter too. Most patients are diagnosed in their mid-30s to late 40s, which reflects how slowly the bone grows combined with the fact that many people reduce their water time after 30.
Symptoms to Watch For
Surfer's Ear: Causes, Symptoms, Prevention & Treatment - Symptoms to Watch For.
Early surfer's ear is often asymptomatic — the growth is there, but you cannot feel it. Symptoms appear as the canal narrows:
- Water retention — water stays trapped in your ear long after a session
- Recurrent ear infections (otitis externa, or swimmer's ear) because trapped water and debris create a breeding ground
- Feeling of fullness or blockage in the ear
- Conductive hearing loss — sound cannot travel efficiently through the narrowed canal
- Ear pain
- Tinnitus (ringing)
- Fluid drainage from the ear
Surfer's Ear vs. Swimmer's Ear
These are frequently confused, and the distinction matters for treatment:
- Surfer's ear is a structural bone growth. It develops over years and does not resolve on its own.
- Swimmer's ear is an infection of the ear canal skin. It can be treated with drops and usually clears up.
The connection: surfer's ear makes swimmer's ear more likely and harder to treat, because trapped water and narrowed passages give bacteria a place to persist. If you get repeated ear infections every season, exostoses may be the underlying cause.
How Surfer's Ear Is Diagnosed
Diagnosis is straightforward and usually starts with a physical exam:
- Medical history — your water activities, typical water temperature, years of exposure, and symptoms.
- Otoscopy — a doctor uses a lighted otoscope to look for bony ridges around the eardrum. Exostoses are visible as smooth, broad-based bumps.
- Hearing test (audiogram) — checks for conductive hearing loss across pitch and loudness ranges.
- CT scan — not routine; typically reserved for surgical planning.
If you spend significant time in cold water, an annual ear check is a cheap, fast way to catch the condition while it is still mild.
Prevention: The Only Way to Stop Progression
There is no medication that reverses exostoses. Prevention is the entire game — once bone has formed, it does not shrink.
1. Wear Earplugs Consistently
This is the single most effective measure. Silicone or vented earplugs keep cold water out of the canal while you are in the water. Consistency matters more than the specific product: wearing plugs on warm days and skipping them on cold ones defeats the purpose.
2. Use a Wetsuit Hood
A neoprene hood shields the ear from both cold water and wind, and it covers the ear canal opening far more reliably than plugs alone. Many cold-water surfers use both.
3. Consider Ear Putty
Ear putty can create a tighter seal than standard plugs, though it tends to muffle hearing more. It is a reasonable option for very cold conditions.
4. Avoid Extreme Conditions When Possible
Skipping sessions during the coldest, windiest days reduces cumulative exposure. Not always realistic, but worth factoring in.
5. Rinse and Dry After Every Session
Flushing out trapped water and drying the canal reduces infection risk. Ear drops designed to clear water can help.
6. Get Regular Ear Exams
Early detection lets you tighten prevention before the canal narrows further. Awareness is genuinely low here — one study found only about two-thirds of surfers knew surfer's ear was preventable at all.
Treatment: What Happens When Prevention Fails
If exostoses are mild and asymptomatic, no treatment is needed beyond continued protection. When the canal becomes significantly blocked, the only option is surgical removal.
Surgical Options
- Drilling — the surgeon removes bone with a drill under local or general anesthesia, using a microscope.
- Osteotome technique — bone is chipped away with a chisel-like instrument, followed by debris cleanup.
Both approaches aim to restore canal diameter. Recovery typically involves keeping the ear dry, and one study recommended ciprofloxacin/hydrocortisone drops for one week post-surgery, with 90% of patients fully healed after four weeks.
Surgical Risks
Exostosis removal is not especially hazardous, but it is not trivial either. Documented complications include:
- Facial nerve paralysis
- Canal stenosis (narrowing from scar tissue)
- Temporomandibular joint prolapse
- Hearing loss
- Persistent bony lip
- Persistent eardrum perforation
This risk profile is exactly why prevention beats surgery. A pair of earplugs costs a fraction of an operation and carries none of the downside.
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Sources and further reading
- Surfer's ear - From Wikipedia, the free encyclopedia
- Exostoses (Surfer’s Ear) - Exostoses are bony growths in your ear canal that can occur due to frequent exposure to cold water. This condition is also known as surfer’s ear.
- Surfer's ear - Understanding the Risks and How to Avoid Them - Surfer's Ear is a condition characterized by abnormal bone growth within the ear canal. How do you avoid it? SurfEars have the answer.
Frequently Asked Questions
Is surfer's ear permanent?
Yes. Once bone has grown, it does not reverse on its own. You can stop it from getting worse with consistent protection, but existing growths remain unless surgically removed.
Can I surf with surfer's ear?
Many people do, especially in mild cases. If you have significant narrowing or recurring infections, talk to an ENT specialist about whether continued exposure is safe and how aggressively to protect your ears.
Do earplugs actually prevent surfer's ear?
They are the most effective preventive measure available. The key is wearing them every session in cold or windy conditions, not occasionally.
Does warm water cause surfer's ear?
It can. Cold water accelerates the process, but any repeated water exposure in the ear canal can contribute. Warm-water surfers are at lower risk, not zero risk.
How long does it take to develop?
It is directly proportional to cumulative exposure time. Some long-term surfers show significant blockage within 10 years; others take decades. Cold water and wind speed up the timeline.
When should I see a doctor?
See an ENT specialist if you have persistent water retention, recurring ear infections, muffled hearing, or a feeling of fullness that does not clear. Do not wait for pain — by then the canal may already be substantially narrowed.
The Bottom Line
Surfer's ear is slow, silent, and largely preventable. The bone growth itself is harmless, but the narrowing it causes leads to infections, hearing loss, and in serious cases, surgery with real risks. The evidence is unambiguous: cold water and wind drive the condition, prevalence among long-term surfers is extremely high, and consistent ear protection is the only reliable way to slow it down.
If you spend time in cold water, treat earplugs and a hood as standard equipment, not optional accessories. And get your ears checked regularly — catching exostoses early is the difference between adjusting your habits and going under the drill.