Surfer’s ear (exostosis) is a condition characterised by benign bony growths that develop within the ear canal. These growths form as the body’s defensive response to protect the eardrum from repeated exposure to cold water and wind. Over years of water exposure, these bony protrusions gradually narrow the ear canal, creating a restricted passage that can trap water, earwax, and debris. Unlike swimmer’s ear (otitis externa), which is an infection, surfer’s ear involves actual structural changes to the ear canal bones. In Singapore, despite our warm climate, the condition affects regular ocean swimmers, sailors, and water sports participants due to constant water exposure combined with wind chill effects during activities.
Surfer’s Ear in Singapore
Surfer’s ear, medically known as exostosis, is a progressive condition where abnormal bone growths develop in the ear canal due to repeated exposure to cold water and wind. While the name suggests it only affects surfers, this condition can impact anyone regularly exposed to cold, wet, and windy conditions—including swimmers, divers, kayakers, and water sports enthusiasts in Singapore’s year-round tropical waters. If you’re experiencing hearing difficulties, recurring ear infections, or a sensation of water trapped in your ears after water activities, understanding surfer’s ear treatment options can help you make informed decisions about your ear health.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Surfer’s Ear?
Types of Surfer’s Ear
Mild Exostosis
In mild cases, the bony growths may occupy a small portion of the ear canal diameter. Patients may experience minimal symptoms, with occasional water trapping after swimming or diving. The growths are typically small and may not require immediate treatment unless they cause recurrent problems.
Moderate Exostosis
Moderate exostosis involves growths that may block a significant portion of the ear canal. At this stage, patients commonly experience frequent ear infections, persistent water retention after water activities, and noticeable hearing reduction. The narrowed canal makes natural drainage difficult, increasing infection risk.
Severe Exostosis
Severe cases present with substantial ear canal obstruction. Patients experience significant hearing loss, chronic ear infections, and a constant sensation of fullness. The severely narrowed canal traps debris easily, making even routine ear cleaning challenging and often requiring professional intervention.
Causes & Risk Factors
Primary Causes
The fundamental cause of surfer’s ear is the ear’s protective response to environmental irritants. When repeatedly exposed to cold water and wind, the temporal bone surrounding the ear canal produces new bone growth as a defensive mechanism. This process occurs gradually over years, with the bone slowly thickening and protruding into the ear canal space. The combination of water temperature and wind exposure can contribute to growth formation, though constant exposure to any water temperature may contribute to the condition.
Risk Factors
- Frequent water exposure: Regular swimming, surfing, or diving
- Cold water activities: Ocean swimming in cooler waters or air-conditioned pools
- Wind exposure: Water sports in windy conditions amplify the cooling effect
- Duration of exposure: Longer sessions in water may increase risk
- Years of participation: Cumulative effect over many years of water activities
- Age started: Beginning water sports at a young age increases lifetime exposure
- Male gender: Men show a higher prevalence, possibly due to greater participation in water sports
- Genetic predisposition: Some individuals may be more susceptible to bone growth formation
Signs & Symptoms
Early Stage Symptoms
- Occasional water trapped in ears after swimming
- Mild hearing reduction that improves once the ears dry
- Intermittent ear fullness sensation
- Slight increase in earwax buildup
Progressive Symptoms
- Frequent ear infections
- Persistent water retention
- Noticeable hearing loss, especially after water exposure
- Difficulty clearing ears when diving
- Constant plugged ear sensation
- Tinnitus (ringing in ears) after water activities
Advanced Stage Symptoms
- Severe hearing impairment affecting daily life
- Chronic ear infections resistant to treatment
- Complete ear canal blockage episodes
- Inability to clear water from ears naturally
- Constant ear pain or discomfort
- Debris accumulation requiring
- frequent professional cleaning
These symptoms typically develop gradually over many years of regular water exposure. Many patients don’t notice early changes until water trapping becomes frequent or infections develop.
Experiencing these symptoms? Don’t wait for them to worsen.
Consult with an ENT specialist for an accurate diagnosis and treatment plan.
When to See an ENT Specialist
Seek medical attention if you experience recurring ear infections, particularly after water activities. Persistent water sensation after swimming, progressive hearing loss, or constant ear fullness warrants professional evaluation. Immediate consultation is necessary if you develop severe ear pain, discharge, sudden hearing loss, or dizziness.
Water sports enthusiasts should consider preventive screening if they’ve participated in regular water activities for several years. During your consultation, the ENT specialist will examine your ear canals using otoscopy, assess the degree of canal narrowing, and evaluate any hearing impact. Early detection allows for preventive measures that may help slow progression and avoid surgery. The consultation includes discussing your water activity patterns, symptom history, and developing a management plan tailored to your lifestyle and condition severity.
Diagnosis & Testing Methods
- Otoscopic Examination: The primary diagnostic tool is otoscopy, where the ENT specialist uses an otoscope to visualise the ear canal directly. This examination reveals the characteristic smooth, pearl-like bony growths protruding from the canal walls. The specialist measures the degree of canal obstruction and documents growth locations, typically finding multiple growths in the anterior and posterior canal walls.
- Microscopic Examination: For detailed assessment, microscopic otoscopy provides magnified visualisation of the exostoses. This examination helps differentiate surfer’s ear from other conditions like osteomas (single bone growths) or soft tissue swelling. The microscope allows precise measurement of canal narrowing percentage, crucial for treatment planning.
- Audiometry Testing: Hearing tests evaluate any conductive hearing loss caused by canal obstruction. Pure tone audiometry measures hearing thresholds across frequencies, while tympanometry assesses middle ear function. These baseline measurements help monitor progression and guide treatment decisions.
- CT Imaging: In severe cases or pre-surgical planning, temporal bone CT scans provide detailed bone structure imaging. The scan reveals the exact extent, location, and density of bony growths, helps identify any middle ear involvement, and assists surgeons in planning the surgical approach if needed.
Treatment Options Overview
Non-Surgical Management
- Preventive Measures: Prevention forms the cornerstone of managing early-stage surfer’s ear. Custom-fitted earplugs designed for water sports create a barrier against water and wind while allowing sound transmission and pressure equalisation. Neoprene ear bands or hoods provide additional protection during water activities. Regular use of alcohol-based ear drops after water exposure helps evaporate trapped water and maintain canal health. These measures can help slow progression in mild cases.
- Medical Management: Regular ear canal maintenance by an ENT specialist may help prevent complications in moderate cases. Professional ear cleaning removes trapped debris and earwax that accumulates behind the growths. Antibiotic ear drops treat infections promptly when they occur. Steroid drops may reduce inflammation during acute episodes. Some patients benefit from regular ear irrigation using specialised techniques that navigate around the bony growths safely.
- Lifestyle Modifications: Adapting water activity habits may help manage symptoms without eliminating beloved sports. Limiting cold water exposure duration, avoiding water activities during ear infections, and using hair dryers on cool settings to dry ears after swimming can reduce problems. Some patients alternate between water and land-based exercises to decrease overall exposure while maintaining fitness.
Surgical Treatment
- Canalplasty Surgery: When canal obstruction is significant or causes recurrent infections and hearing loss, surgical removal (canalplasty) may become necessary. This delicate procedure involves removing the bony growths while preserving the ear canal skin and protecting vital structures. The surgery typically takes 1-2 hours per ear under general anaesthesia.
- Surgical Techniques: Modern surgical approaches include the traditional post-auricular approach through an incision behind the ear, or the transcanal approach working directly through the ear canal for smaller growths. Surgeons use specialised drills, curettes, and sometimes lasers to carefully remove excess bone. The choice of technique depends on growth location, size, and surgeon expertise. Contemporary techniques like piezoelectric surgery offer precise bone removal with minimal trauma to surrounding tissues.
- Post-Surgical Care: Recovery requires keeping the ear completely dry while the canal heals. Patients use protective ear covers when showering and avoid all water activities during this period. Regular follow-up appointments monitor healing progress and remove any packing materials. Patients may resume water activities after recovery with proper ear protection. Individual results and timelines may vary.
Every patient’s condition is unique.
Our ENT Specialist will assess your specific situation and recommend the most suitable treatment approach for you.
Complications if Left Untreated
Untreated surfer’s ear progressively worsens, potentially leading to complete ear canal closure in severe cases. This total obstruction causes permanent conductive hearing loss that significantly impacts quality of life and communication. Chronic ear infections may become increasingly frequent and difficult to treat as the narrowed canal traps bacteria and moisture, potentially leading to serious complications like mastoiditis or cholesteatoma formation.
The constantly moist environment behind the bony growths creates conditions for fungal infections, which are particularly challenging to eliminate. Trapped debris and earwax can form impactions that cause sudden hearing loss and require emergency removal. Some patients develop chronic ear canal inflammation (external otitis) that causes persistent pain and discharge. Advanced cases may experience complications during future ear procedures or surgeries, as the altered anatomy makes access difficult. The psychological impact of progressive hearing loss, including social isolation and reduced participation in water activities, significantly affects overall well-being.
Prevention
Consistent use of properly fitted earplugs during all water activities provides effective prevention against surfer’s ear development and progression. Custom-moulded surf earplugs offer protection compared to generic options, creating a watertight seal while allowing sound transmission for safety. Wearing neoprene hoods or headbands provides additional wind protection, particularly important during winter months or windy conditions.
Limiting exposure time in cold water and taking regular breaks during long sessions reduces cumulative irritation to the ear canal. After each water session, tilting the head to drain water naturally and using alcohol-based ear drying drops helps maintain canal health. Avoid using cotton swabs, which can push debris deeper and irritate the canal lining. Regular ENT check-ups for active water sports participants enable early detection of growth formation. Teaching young water sports enthusiasts about ear protection establishes lifelong preventive habits before significant damage occurs.
Frequently Asked Questions (FAQ)
Can surfer’s ear develop in Singapore’s warm waters?
Yes, surfer’s ear can develop even in tropical climates like Singapore. While cold water may accelerate the condition, any repeated water and wind exposure can trigger bone growth formation. Singapore’s year-round water sports culture, combined with air-conditioned pools and ocean wind exposure, creates conditions for exostosis development. Regular swimmers, sailors, and divers in Singapore waters should take preventive measures regardless of water temperature.
How long does recovery from surfer’s ear surgery take?
Recovery from canalplasty surgery varies by individual. The ear must stay completely dry while the canal skin heals. Patients return to normal daily activities within several weeks but must avoid water exposure during recovery. Hearing improvement may occur once packing is removed, though full results may take time. Water sports can usually resume after recovery with proper ear protection and surgeon clearance.
Will surfer’s ear grow back after surgery?
Surfer’s ear can potentially regrow if you continue water activities without protection after surgery. Regrowth rates vary depending on post-surgical water exposure and preventive measures taken. Consistent use of custom earplugs and limiting cold water exposure may reduce recurrence risk. Patients who adopt proper protective measures after surgery may not experience clinically significant regrowth requiring repeat procedures.
What’s the difference between surfer’s ear and swimmer’s ear?
Surfer’s ear (exostosis) involves actual bone growth in the ear canal, developing over years of water exposure, while swimmer’s ear (otitis externa) is an acute infection of the ear canal skin. Surfer’s ear is a structural problem that may require surgical treatment in severe cases, whereas swimmer’s ear is treated with antibiotic drops and keeping the ears dry. Surfer’s ear patients may experience frequent swimmer’s ear infections due to water trapping.
Can children develop surfer’s ear?
Children can begin developing surfer’s ear if they participate in regular water activities from a young age. The bone growth process is cumulative, so starting water sports early increases lifetime exposure risk. Significant symptoms typically don’t appear until the teenage years or adulthood. Parents should ensure children use appropriate ear protection during water activities to prevent future problems.
Is surfer’s ear surgery painful?
The surgery itself is performed under general anaesthesia, so patients feel no pain during the procedure. Post-operative discomfort varies by individual and is typically managed with prescribed pain medication. Patients may describe the sensation as ear fullness or pressure rather than sharp pain. Discomfort usually subsides within several days, though some ear sensitivity may persist during the healing period.
Can I continue water sports if I have mild surfer’s ear?
Yes, you may continue water sports with mild surfer’s ear by taking proper precautions. Wearing custom-fitted earplugs during all water activities is essential to help prevent progression. Regular ENT monitoring tracks any changes. Using ear drying drops after each session and avoiding water activities during ear infections helps maintain ear health. Many athletes successfully manage mild surfer’s ear with consistent preventive measures.
What are the costs involved in surfer’s ear treatment in Singapore?
Treatment costs vary depending on severity and chosen approach. Initial consultation and diagnosis with an ENT specialist includes examination and possible hearing tests. Custom earplugs for prevention are a worthwhile investment for long-term protection. Surgical treatment costs depend on complexity and whether one or both ears require treatment. Patients may find early preventive measures more cost-effective than eventual surgical intervention.
For Singaporeans & Singapore Permanent Residents
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Conclusion
Surfer’s ear is a progressive condition that affects dedicated water sports enthusiasts, but understanding your treatment options empowers you to protect your hearing while continuing the activities you love. From preventive measures using custom earplugs to surgical techniques for severe cases, modern ENT care offers effective solutions for every stage of exostosis. Early recognition and appropriate management may help prevent the condition from impacting your quality of life or forcing you to abandon water sports. Whether you’re experiencing early symptoms or dealing with advanced surfer’s ear, professional evaluation helps ensure you receive the right treatment approach for your specific situation and lifestyle needs.
Take the First Step Towards Better Ear Health
Living with surfer’s ear can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating surfer’s ear using evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He underwent his subspecialty training in Rhinology (Nose & Sinus conditions) and Endoscopic Skull Base Surgery at the renowned St Paul’s Sinus Center, part of the University of British Columbia in Vancouver, Canada. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
Make an Enquiry
Fill up the form and our friendly clinic staff will get back to you promptly.
Our Location
A Specialist Clinic for Sinus, Snoring & ENT
38 Irrawaddy Road #08-45
Mount Elizabeth Novena Hospital
Singapore 329563
Mon – Fri: 9:00 am – 5:00 pm
Sat: 8:30 am – 12:00 pm