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NEUROIMAGE
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 1520-1521

Bilateral exostosis of the external auditory canal: Surfer's ear


Department of Radiology, Columbia Asia Referral Hospital, Bengaluru, Karnataka, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. Sriram S Patwari
Department of Radiology, Columbia Asia Referral Hospital, 26/4, Brigade Gateway, Beside Metro Cash and Carry West, Malleshwaram, Bengaluru, Karnataka - - 560 055
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.241360

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How to cite this article:
Patwari SS, Joshi S, Chadaga HC. Bilateral exostosis of the external auditory canal: Surfer's ear. Neurol India 2018;66:1520-1

How to cite this URL:
Patwari SS, Joshi S, Chadaga HC. Bilateral exostosis of the external auditory canal: Surfer's ear. Neurol India [serial online] 2018 [cited 2018 Oct 23];66:1520-1. Available from: http://www.neurologyindia.com/text.asp?2018/66/5/1520/241360




We present a case of a 43-year old male patient with a progressive decrease in hearing in the right ear for 10 months. On examination, there was stenosis of bilateral bony external ear canal with no signs of infection. The patient underwent a high-resolution computed tomography (CT) of the temporal bones, which showed significant thickening of the anterior and posterior walls of bilateral bony external ear canals deep to the isthmus, causing severe narrowing of the lumen [Figure 1]. A soft tissue density was also noted within the right external auditory canal, suggesting the presence of impacted cerumen.
Figure 1: CT Bone window axial and coronal images of temporal bone demonstrate thickening of the anterior and posterior walls of the right (a--b) and left (c--d) bony external ear canal deep to isthmus causing significant narrowing of the lumen bilaterally. Soft tissue density is noted within the right external auditory canal suggestive of impacted cerumen (a--b)

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Exostosis of the external auditory canal is a relatively rare lesion but is the commonest tumor of the bony external ear.[1] It results from benign hyperplasia of the lamellar bone secondary to chronic thermal, physical, or chemical trauma. In the pre-antibiotic era, chronic aural infection was the most common cause of exostosis. In the present day scenario, chronic exposure to cold sea water, in activities such as surfing, swimming, and diving, is the most common cause of exostosis,[2] and hence, the condition has been called the “surfer's ear.” Most patients present with unilateral hearing loss, pain, and tinnitus due to impacted cerumen secondary to the narrowing of the lumen of the external auditory meatus, although radiologically, findings are almost always bilateral.

The key diagnostic features are the proliferation and thickening of bony walls of bilateral external auditory meati deep to the isthmus, most commonly involving the tympanic ring between the tympano-squamous suture anteriorly, and the tympano-mastoid suture posteriorly. The imaging differential diagnosis includes an external ear osteoma, which is usually unilateral, pedunculated, and occurs lateral to the isthmus.



 
  References Top

1.
Turetsky DB, Vines FS, Clayman DA. Surfer's ear: Exostoses of the external auditory canal. Am J Neuroradiol 1990;11:1217-8.  Back to cited text no. 1
    
2.
Di Bartolomeo JR. Exostoses of the external auditory canal. Ann Otol Rhinol Laryngol 1979;88(Suppl 61):1-20.  Back to cited text no. 2
    


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