What Is Surfer’s Ear? Causes, Symptoms, and Treatment

Surfer’s ear is a condition in which small bony growths develop inside the ear canal in response to repeated exposure to cold water and wind. The medical name is external auditory exostosis, and despite what it sounds like, you do not need to be a surfer to get it. These bony lumps are benign, but over time they can narrow the ear canal enough to trap water, cause recurring infections, and muffle hearing. The condition is remarkably common among people who spend years in the water, and it progresses so gradually that many people don’t realize anything is wrong until the canal is substantially blocked.

How Bony Growths Form in the Ear Canal

The ear canal is lined with thin skin stretched over bone. When cold water and wind repeatedly chill that bone, the body responds by laying down new layers of bone on the canal walls, essentially trying to wall off the sensitive inner ear from the cold. The growths tend to appear on the front and back walls of the canal, close to the eardrum, and they usually show up in both ears. A comprehensive systematic review of studies on surfers confirmed that cold water exposure combined with wind and prolonged time in the water all contribute to the development of these growths.¹

The process is slow. It takes years of regular exposure before the growths become large enough to notice. The bone builds up in thin layers, so the lumps are hard and smooth, not rough or crumbly like a tumor. Because the canal is narrow to begin with, even small growths can start to cause problems once they encroach on enough of the opening.

Does the Water Have to Be Cold?

Cold water has long been considered the primary trigger, and most of the research has focused on surfers in cooler oceans. But a study of surfers on Australia’s Gold Coast, where water temperatures are warm year-round, found that about 72% of them had some degree of exostosis.² That is a striking number given that cold water is supposed to be the main driver. In cold-water surfing populations, reported rates typically range from about 61% to 80%, so the warm-water prevalence is right in that same range.

The same Australian study tried to pin down which specific factors predicted who would develop exostosis and how severe it would be. Researchers looked at age, surfing experience, winter exposure, skill level, use of protective gear, and history of ear infections, and none of those factors showed a statistically significant correlation with either the presence or the severity of the growths.² That doesn’t mean those factors are irrelevant, but it does suggest that the relationship between water temperature, wind, and bone growth is more complicated than a simple dose-response curve. Wind chill, evaporative cooling when wet ears are exposed to breeze, and individual anatomy may all play a role that current studies haven’t fully untangled.

Not Just Surfers

The name “surfer’s ear” is catchy, but it gives the wrong impression about who is at risk. Anyone who spends significant time with water sloshing in their ears can develop exostosis. A study of white-water kayakers found that they are the first inland population to develop exostosis at rates comparable to coastal surfers.³ That’s meaningful because white-water kayakers deal with cold river water and plenty of wind but no salt water, which suggests that saltwater exposure specifically is not a necessary ingredient.

Swimmers, divers, windsurfers, kitesurfers, and sailors have all been documented with exostosis. The common thread is repeated exposure of the ear canal to water and moving air, not the specific sport. People who fish commercially or work on boats for a living can develop it too. The condition also appears in archaeological records. A study of prehistoric human remains from Santa Rosa Island in California found that exostosis patterns matched the gender differences you’d expect if the growths were linked to cold-water food harvesting activities like diving for abalone.⁴ People have been getting surfer’s ear for thousands of years, long before anyone picked up a surfboard.

Symptoms and Why They Sneak Up on You

The early stages of surfer’s ear are usually silent. The growths are small, and the ear canal is still open enough to drain normally. Most people have no idea anything is happening until the obstruction becomes significant, which can take a decade or more of regular water exposure.

As the growths enlarge, the most common problems are:

Water trapping: The narrower canal can’t drain as efficiently after a surf session or swim, and water gets stuck behind the bony lumps. This creates a warm, moist pocket that is ideal for bacterial growth.
Recurring ear infections: Repeated episodes of otitis externa, the painful outer-ear infection sometimes called swimmer’s ear, are one of the most frequent reasons people finally get checked. It’s not just bad luck with infections; the anatomy is literally trapping bacteria.
Hearing loss: When the bony growths block enough of the canal, sound has a harder time reaching the eardrum. This is conductive hearing loss, the kind caused by a physical barrier rather than nerve damage. A case report documented bilateral exostosis causing this type of hearing loss in a surfer, with the growths significantly narrowing both ear canals.⁵
Earwax buildup: The narrowed canal makes it harder for earwax to migrate outward the way it normally does. Cerumen impaction on top of an already narrowed canal can make hearing loss worse than the bone alone would cause.
A fullness or pressure sensation: Some people describe a plugged feeling in the affected ear, especially after being in the water.

The tricky part is that these symptoms tend to be intermittent early on. Your ear might feel fine most of the time and only give you trouble after a session in colder or windier conditions. That intermittent pattern can lead people to write off the problem for years, treating individual infections with drops rather than investigating why they keep happening.

How Surfer’s Ear Is Diagnosed and Graded

A doctor can usually see exostosis with a standard otoscope, the handheld tool used to look in your ears during a routine checkup. The growths appear as firm, smooth, rounded bumps protruding from the canal walls. They are typically found on both the front and back walls of the canal, closer to the eardrum than the outer opening.⁶ Unlike the softer, waxy buildup of cerumen, these bumps are bone-hard when touched with an instrument.

The severity is graded on a scale based on how much of the canal’s opening is blocked. Grade 0 means no exostosis. Grade 1 is mild, with less than a third of the canal narrowed. Grade 2 means roughly a third to two-thirds is blocked. Grade 3 means more than two-thirds of the canal is obstructed. In the Australian warm-water surfer study, most affected surfers fell into the mildest category.²

When surgery is being considered, a CT scan of the temporal bone becomes the essential tool. CT imaging shows the exact size, location, and depth of the growths and their relationship to the eardrum and the facial nerve, which runs close to the back wall of the ear canal. Surgeons need to know precisely how far inward the bone extends, whether there are any problems in the middle ear behind the eardrum, and where the facial nerve sits, because accidental injury to that nerve during surgery could cause facial paralysis.⁷

Prevention With Ear Protection

Since the growths develop from repeated cold water and wind exposure, the most direct preventive strategy is keeping those stimuli out of the ear canal. Earplugs and neoprene hoods are the two main options, and the evidence suggests earplugs are effective when they actually seal well. One study found that swimmers using earplugs had no water in the ear canal 93% of the time.⁸

Not all earplugs are created equal, though. Moldable silicone wax plugs and polymeric foam plugs treated with a thin layer of petroleum jelly provided a high level of water protection in testing. Cotton plugs treated with petroleum jelly and hard acrylic earplugs did not keep water out reliably.⁸ Custom-molded silicone plugs shaped to fit your individual ear canal tend to offer the best combination of seal, comfort, and staying power during vigorous activity. Off-the-shelf designs vary a lot, and a plug that fits one person perfectly may leak in another.

The practical challenge is that many water sports enthusiasts simply don’t wear ear protection. Usage rates are low across the studied populations, with wide regional variation. In surfing culture, earplugs have sometimes been seen as unnecessary or uncomfortable. But given that more than two-thirds of long-term surfers may already have some degree of exostosis whether they know it or not, earplug adoption is probably the single most impactful thing you can do if you plan to spend decades in the water. A neoprene hood adds a second layer of windchill protection, which matters because the cooling effect of wind on a wet ear canal may be as significant as the water itself.

When Surgery Becomes Necessary

Most people with mild exostosis never need surgery. The growths don’t go away on their own, but if they aren’t causing recurrent infections, significant hearing loss, or persistent symptoms, there’s no urgency to remove them. Surgery is typically reserved for higher-grade obstruction where the canal is blocked enough that it can’t clear water or wax effectively, or where infections keep coming back despite conservative management.

The operation involves chiseling or drilling away the bony growths from inside the ear canal to restore a normal-width opening. There are two main approaches to bone removal: an osteotome, which is essentially a small chisel that chips away bone; and a drill, which grinds it down. A meta-analysis pooling data from 15 studies covering about 1,400 patients found that both techniques carry real but manageable risks. The most common complication was a tear in the eardrum, occurring in roughly 5% of ears treated with the chisel and about 4% with the drill. Sensorineural hearing loss, the more serious kind caused by nerve damage rather than a physical blockage, occurred in under 1% of chisel cases but in about 4% of drill cases. Post-surgical narrowing of the canal from scar tissue happened in about 1% with the chisel and 4% with the drill.⁹

Those numbers suggest the chisel technique has a somewhat better profile for nerve-type hearing loss and scarring, though it carried a slightly higher rate of eardrum tears. A separate large series comparing different bone-removal methods found no significant difference in eardrum perforation rates between approaches, and noted that a combined osteotome-and-aspiration technique had the lowest or near-lowest rates of all post-operative symptoms analyzed, including tinnitus.¹⁰ The takeaway is that surgical technique matters, and if you’re facing this operation, it’s worth finding a surgeon who has done it many times and can discuss which method they prefer and why.

Recovery typically involves keeping the ear dry for several weeks while the canal heals. Packing material is placed in the canal during recovery to prevent scar tissue from narrowing the canal again. Eardrum tears, when they happen, usually heal on their own, though occasionally they require a separate repair.

Can It Come Back After Surgery?

Yes. Surgery removes the existing bony growths, but it does nothing to change the underlying mechanism. If you go back to surfing, kayaking, or any cold-water activity without ear protection, the bone will start growing again. The biology hasn’t changed; you’ve just reset the clock. This is one of the strongest arguments for taking ear protection seriously after surgery. Patients who continue water sports without plugs or hoods are essentially signing up for a second operation down the road. The regrowth typically takes years, just as the original growths did, but it does happen.

Surfer’s Ear Versus Osteoma

One common point of confusion is the difference between exostosis and osteoma, two bony growths that can appear in the ear canal but are quite different. Exostosis produces multiple small, broad-based bumps made of dense layered bone, almost always affecting both ears. It is clearly linked to environmental exposure. Osteoma, by contrast, is usually a single rounded growth attached to the canal wall by a narrow stalk, and it tends to occur on just one side. Osteomas are not related to water or cold exposure. They grow from a different type of bone formation and are thought to arise more randomly. A doctor examining your ear can usually tell the two apart by their appearance and location, but CT imaging confirms the distinction when needed. The treatment for a symptomatic osteoma is also surgical removal, but the clinical significance and the patient population are different.

Evidence From Ancient Populations

Surfer’s ear has a deep history that long predates recreational surfing. Anthropologists have identified exostosis in skeletal remains from coastal populations around the world, using it as a marker for how those communities used marine resources. On Santa Rosa Island off the coast of Southern California, researchers examined human remains spanning thousands of years of prehistory. They found that exostosis rates differed between males and females in ways consistent with a gendered division of labor where men did more cold-water diving for shellfish than women did.⁴ Similar patterns have been found in Neanderthal remains and in coastal populations across Europe and Asia.

This archaeological perspective reinforces something that the medical literature sometimes underemphasizes: surfer’s ear is not a disease in the traditional sense. It is an adaptive response by bone to environmental stress, the same basic mechanism by which bones thicken in response to mechanical loading during exercise. The response itself is normal biology. The problem is only that the ear canal is so narrow that even a normal adaptive response can create a clinical obstruction. In a wider passageway, the same amount of bone growth would go unnoticed. The ear canal is simply an inconvenient place for your skeleton to demonstrate its remodeling skills.

1
PubMed. External auditory exostosis among surfers: a comprehensive and systematic review
2
PubMed Central. Auditory exostosis in Australian warm water surfers: a cross-sectional study
3
PubMed. Exostoses of the external auditory canal in white-water kayakers
4
International Journal of Osteoarchaeology. External Auditory Exostoses and its Relationship to Prehistoric Abalone Harvesting on Santa Rosa Island, California
5
PubMed Central. Bilateral External Auditory Exostoses Causing Conductive Hearing Loss: A Case Report and Literature Review of the Surfer’s Ear
6
International Journal of Case Reports and Images. Progressive hearing loss: A case report on surfer’s ear
7
European Society of Radiology. From CT to Surgery: Radiological Essentials for EAC Exostoses Management
8
PubMed Central. What do windsurfers and kitesurfers in Germany know about surfer’s ear and how is it influenced by protective measures?
9
PubMed. Complication Rates in Osteotome and Drill Techniques in External Auditory Canal Exostoses: A Systematic Review and Meta-Analysis
10
PubMed. Transcanal Excision of Exostoses: Large Series Comparing Bone Removal Methods