Understanding Surfer’s Ear (External Auditory Exostosis)

Surfer’s ear (external auditory exostosis, or EAE) is a condition where repeated exposure to cold water and wind causes gradual bony growth inside the ear canal.

 Over time, these bone growths narrow the canal and can lead to:

• trapped water

• recurrent ear infections

• wax buildup

• hearing changes

• pressure or fullness in the ear

Surfer’s ear is extremely common among long-term surfers, with studies showing prevalence rates ranging from 53–90% in surfers worldwide.[1]

Why surfers develop it?

Cold water exposure appears to stimulate new bone formation inside the ear canal. Wind exposure may accelerate this process even further.

Risk increases with:

• years of surfing

• colder water temperatures

• winter surfing

• frequent sessions

• wind exposure

• competitive or professional surfing

One study estimated surfer’s ear risk increases by approximately 12% for every additional year of surfing.[4] Cold-water surfers may have nearly a 6-fold higher risk compared to warm-water surfers.[5]

Common Symptoms

• water trapped after surfing

• recurrent swimmer’s ear/infections

• muffled hearing

• ear fullness or pressure

• wax accumulation

• discomfort in cold water or wind

Because the condition develops gradually, many surfers do not realize how narrowed the canal has become until symptoms become frequent.

Prevention

Earplugs are the most effective prevention strategy

Multiple studies show that surfers who consistently wear ear protection develop less severe exostosis over time.[6]

Helpful prevention strategies include:

• surf-specific earplugs

• neoprene hoods in cold water

• drying ears after surfing

• avoiding prolonged cold-water exposure when possible

Many surfers avoid earplugs because they worry about balance or hearing changes, but modern surf earplugs are significantly lower profile and better ventilated than older designs.

Recommended Ear Protection

Best Overall: SurfEars

Designed specifically for surfers, SurfEars allow sound to pass through while helping keep water out—making them one of the best options for long-term prevention.

Alternative Option: Debrox Swimmer’s Ear Drops

A simple option to help dry the ear canal after surfing and reduce discomfort from trapped water.

Grading Scale

Surfer’s ear is commonly graded by how much the ear canal becomes blocked.

Grade 1 (Mild) <33% obstruction

• usually minimal symptoms

• occasional trapped water

Grade 2 (Moderate) 34–66% obstruction

• more frequent water trapping

• wax buildup

• intermittent hearing reduction

Grade 3 (Severe) 66% obstruction

• recurrent infections

• significant blockage/fullness

• conductive hearing loss

• symptoms often become persistent

Symptoms tend to increase significantly once the canal becomes more than two-thirds obstructed.[2]

When surgery is considered

Most surfers can manage symptoms conservatively for years. Surgery (canaloplasty) is usually reserved for:

• severe canal obstruction

• recurrent infections

• persistent water trapping

• significant hearing loss

Procedures remove excess bone and reopen the canal.

Several surgical techniques exist:

• osteotome/chisel

• drill-assisted removal

• newer piezoelectric approaches

• endoscopic techniques

Recovery can take several weeks, making prevention especially important.

From a Surfer + Medical Perspective

One of the biggest misconceptions about surfer’s ear is that it only affects older surfers. In reality, the process can begin much earlier than many people realize — especially in surfers with consistent cold-water exposure.

From a medical standpoint, the condition is progressive and largely preventable. From a surfer’s perspective, many people ignore symptoms until water trapping and infections start affecting sessions regularly.

Modern surf earplugs have improved significantly and are worth considering even for surfers without symptoms yet.

References

1. Vallée A. Eur Arch Otorhinolaryngol. 2024.

2. Wegener F, et al. Eur Arch Otorhinolaryngol. 2022.

3. Rhys Evans PH, Cameron M. Ann R Coll Surg Engl. 2017.

4. Alexander V, et al. Eur Arch Otorhinolaryngol. 2015.

5. Kroon DF, et al. Otolaryngol Head Neck Surg. 2002.

6. Lambert C, et al. Eur Arch Otorhinolaryngol. 2021.