Auditory Exostosis in Australian Warm Water Surfers: a Cross-sectional Study

Background: Surfing is a popular sport in Australia, accounting for nearly 10 percent of the population. External auditory exostosis (EAE), also referred to as surfer’s ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19⁰C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80 percent.However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19⁰C. With mean water temperature ranging from 19°C to 28°C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers. Methods: Eligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy. Results: A total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment. Conclusion: To the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 o C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.