Almost all lifelong surfers get some degree of exostosis, but the condition commonly known as "surfer's ear" will likely require surgical intervention in those who don't wear earplugs.
Surfer's ear is the result of benign bone growth under the skin of the outer ear canal.
It usually affects water sports enthusiasts - surfers, windsurfers and kiteboarders, swimmers, divers, kayakers, sailors, etc. - living and practicing their outdoor activity in cold environments.
The surfer's ear becomes more acute and severe over time, especially when sportsmen and sportswomen reach their 30s and 40s, having surfed a decade, or more, without ear protection.
Surfer's ear is irreversible and can only be treated with proper surgery.
When ears are exposed to cold water and cold winds for a long time, our body tries to protect the auditory system from the low temperatures by building a first line of defense.
In the most extreme cases, the new cartilage completely shuts off the ear canal, leading to ear infections - for example, acute otitis media (AOM) - tinnitus (ringing in the ears), and even hearing loss.
Half of the surfers with surfer's ear will only develop a mild form of exostosis, i.e., when small bony lumps block only less than one-third of the ear canal.
Then, there's the moderate surfer's ear (between 33 and 66 percent of blockage) for a quarter of riders and a severe condition for another quarter.
Someone with 75 percent (or more) of surfer's ear should consider surgery because the amount of ear closure leaves a tiny opening for air and sound to reach the eardrum.
Simultaneously, earwax and water are trapped and will block your ears even further.
Surfer's Ear: Surgery and Prevention
Surfer's ear is a silent abnormal condition and causes few symptoms. Initially, there's no pain and no bleeding.
But in a matter of months, you start losing hearing and feeling there's something wrong with one of your ears.
When it happens, immediately contact an otorhinolaryngologist, and get a pair of silicone earplugs.
You should start using them in the shower and in all of your surf sessions, whether it's winter or summer.
If your doctor advises you to undergo ear surgery, don't think twice.
Go for it. The surgeon will remove the obstructing bone by drilling the unwanted lumps, all under general anesthesia.
The healing process keeps water sports participants out of the water for between four weeks and three months.
The first signs of exostosis appear in surfers with five years of water sports involvement.
Wave riders who surf in water temperatures below 60 °F (15.5 °C) have 2.6 times more chances of developing severe exostoses.
Also, the worst ear is generally the one exposed to the prevailing wind.
For example, if you're surfing in California, sitting on your surfboard waiting for the waves, and the wind is blowing from the north, your right ear will be more exposed to the cold wind than your left ear.
Don't forget that the colder it gets, the faster you'll develop surfer's ear.