Symptoms, Effects on Hearing, and Treatment Options
Bony growths developing in the external ear canal are often described by patients as bone formation in the ear, bone growth in the ear canal, or narrowing of the ear canal. The two most common causes of this condition are external ear canal exostosis and ear osteoma. Although both are benign, as they grow they can narrow the ear canal, leading to ear blockage, frequent infections, and occasionally conductive hearing loss.
These conditions typically progress slowly and may not cause symptoms in the early stages. However, as the narrowing of the ear canal increases, feelings of fullness after water exposure, wax buildup, and recurrent outer ear infections become more frequent.
Why Do Exostosis and Osteoma Form?
External ear canal exostosis consists of multiple, broad-based bony projections that develop in the ear canal. The most common cause is prolonged exposure of the ear canal to cold water and wind. For this reason, it is more frequently seen in swimmers, divers, and those involved in water sports, and is commonly known as surfer’s ear. Exostosis usually develops in both ears simultaneously and symmetrically, potentially causing ear canal narrowing over time.
Ear osteoma, on the other hand, is typically a single, round, pedunculated bony growth. It is usually unilateral and has no association with cold water. It grows slowly and is most often discovered incidentally during a routine ear examination. However, as it enlarges, it may cause a sensation of fullness, blockage, and occasionally reduced hearing.
What Symptoms Does It Cause?
As the ear canal narrows, the following complaints may arise:
- Sensation of fullness and pressure in the ear
- Persistent blockage after water exposure that does not resolve quickly
- Frequent earwax buildup
- Recurrent outer ear infections
- Occasionally mild hearing loss
Hearing loss is generally in the form of conductive hearing loss resulting from the narrowing of the ear canal and is mild in most patients.
Is a Hearing Test (Audiometry) Necessary?
For patients with significant ear canal narrowing, audiometry (hearing test) is recommended. Audiometry allows assessment of whether hearing levels are normal, the degree of any existing loss, and whether it is conductive in nature. In most patients, hearing is normal or only mildly affected.
How Is the Diagnosis Made?
The diagnosis is usually made through a detailed ear examination. In cases where it is necessary to assess the degree of bony structures and the extent of narrowing in the ear canal, temporal bone computed tomography (CT) may be requested. Imaging is particularly helpful from a surgical standpoint in patients for whom external ear canal surgery is planned.
When Is Surgery Required?
Not every case of exostosis or osteoma requires surgery. If there are no symptoms and the ear canal is sufficiently open, regular follow-up is sufficient. However, exostosis surgery or osteoma removal may be recommended in the following situations:
- Significant narrowing of the ear canal
- Frequent outer ear infections
- Persistent earwax blockage
- Development of hearing loss
- Ear blockage affecting daily life
How Is the Surgery Performed?
External ear canal exostosis or osteoma surgery is performed under general anesthesia using an operating microscope. During the procedure, excess bony tissue is carefully drilled away using a specialized fine-tipped micromotor (drill) system to widen the ear canal.
An important aspect of this surgery is that the procedure is performed exclusively within the external ear canal. The area behind the eardrum is not accessed and the middle ear is not entered. The eardrum is preserved and the natural width of the ear canal is restored.
Post-Operative Process
Recovery after surgery is generally rapid. Patients are advised to protect their ears from water and infection for a period of time. As the ear canal is opened, most patients experience resolution of ear blockage, and any mild conductive hearing loss may also improve.
In patients with exostosis, protection is important as continued exposure to cold water may lead to the development of new bone formation over the years.
Frequently Asked Questions (FAQ)
1- Are exostosis and osteoma cancerous?
No. Both are benign bony growths and do not transform into cancer.
2- Can bone formation in the ear cause hearing loss?
Yes, but it is usually mild and presents as conductive hearing loss due to narrowing of the ear canal.
3- Is audiometry necessary?
Audiometry is recommended in patients with a narrowed ear canal to evaluate hearing status.
4- Does every patient require surgery?
No. If there are no symptoms and the ear canal is open, follow-up is sufficient.
5- How is exostosis surgery performed?
Under general anesthesia, excess bony tissue in the external ear canal is removed using a microscope and drill system.
6- Is the area behind the eardrum accessed during surgery?
No. The procedure is performed solely within the external ear canal; the middle ear is not entered and the eardrum is preserved.
7- Can it recur after surgery?
If cold water exposure continues, exostosis in particular may redevelop over the years.
8- What should be done if there is persistent ear blockage?
A consultation with an Ear, Nose and Throat specialist is essential before using cotton swabs.
As Prof. Dr. Gediz Murat Serin, my approach to these conditions is to provide an evaluation that is as conservative as possible and avoids unnecessary surgery. The majority of patients with exostosis and osteoma do not require surgery and can continue their lives without issues under observation alone. The decision for surgery is made only in cases that significantly affect the patient’s quality of life and following a detailed evaluation. When surgery is indicated, it is planned to target only the external ear canal, performed under a microscope using precise techniques.
