Surfer’s ear is a condition where small bony growths develop inside the ear canal in response to repeated exposure to cold water and wind. The medical term is exostosis, and it affects roughly 38% of surfers overall, with significantly higher rates among those who surf in colder waters. Left untreated, these growths can narrow the ear canal enough to trap water, cause recurring infections, and eventually reduce hearing.
How Cold Water Triggers Bone Growth
The ear canal is lined with thin skin stretched directly over bone, with almost no insulating tissue in between. When cold water and wind repeatedly hit this area, the bone responds by producing new layers of growth, gradually narrowing the canal. These growths, called exostoses, typically develop on the walls closest to the front and back of the inner ear canal and are covered with normal-looking skin.
The exact biological trigger isn’t fully understood. What is clear is that the colder and more frequent the exposure, the faster the growths develop. Water temperatures in the mid-60s Fahrenheit (around 18°C) or lower pose the greatest risk, and the condition is most common among surfers in regions with consistently cold water. But surfers aren’t the only ones affected. Kayakers, divers, sailors, and anyone who spends significant time in cold water can develop it.
Who Gets It and How Quickly
A large study of surfers found that cold water exposure was the single biggest risk factor, with surfers in colder waters nearly six times more likely to develop exostoses than those in warmer conditions. Professional surfers were about four times more likely to have the condition than recreational surfers, largely because of the sheer number of hours they spend in the water.
Time matters enormously. Each additional year of surfing increases the risk of developing exostoses by about 12%, and the risk of developing more severe growths increases by 10% per year. This means surfer’s ear is largely a condition of accumulation. Someone who surfs cold water for five years may have mild, unnoticeable growths. After 15 or 20 years, those same growths may have closed off most of the ear canal. Interestingly, surfers with more severe growths were also more willing to surf in colder conditions, suggesting that the people most at risk are often the least deterred by cold.
Symptoms at Each Stage
In its early stages, surfer’s ear causes no symptoms at all. The bony growths are small enough that water flows in and out of the ear normally. Most people have no idea anything is happening.
As the canal narrows, the first noticeable sign is water getting stuck in the ear after sessions. You might find yourself tilting your head and hopping on one foot more often, or notice that one ear takes much longer to drain than the other. This trapped water creates a warm, moist environment that bacteria love, so recurring ear infections become common. You may experience pain, itching, or discharge from the ear, sometimes several times a year.
In more advanced cases, the growths can block 80% to 90% of the ear canal. At this point, hearing loss becomes noticeable, particularly a muffled quality on the affected side. Some people also experience ringing in the ear. Because the growths develop over years or decades, many surfers adapt gradually and don’t realize how much hearing they’ve lost until a doctor examines them.
Surfer’s Ear vs. Swimmer’s Ear
These two conditions are often confused, but they’re fundamentally different problems. Swimmer’s ear (otitis externa) is a skin infection of the ear canal. The canal becomes red, swollen, and painful, often with visible discharge. It develops over days, responds to treatment, and clears up completely.
Surfer’s ear is a structural change to the bone itself. The skin covering the growths looks perfectly normal. It develops over years, not days, and it doesn’t resolve on its own or with medication. The connection between the two is that surfer’s ear makes swimmer’s ear more likely, because narrowed canals trap water and create ideal conditions for infection. If you keep getting swimmer’s ear despite doing everything right, bone growths may be the underlying cause.
Prevention
The most effective prevention is keeping cold water and wind out of your ear canals. Custom-molded earplugs designed for water sports are the gold standard. They seal the canal while still allowing enough sound through for situational awareness. Off-the-shelf silicone plugs work too, though they tend to fit less reliably and can fall out in heavy surf.
Wearing a neoprene hood or headband adds another layer of protection, particularly in very cold conditions where wind chill compounds the effect of cold water. Even partial protection makes a difference. Because the risk increases by a measurable percentage each year, reducing exposure intensity at any point slows the progression of existing growths and delays the development of new ones.
Drying your ears thoroughly after each session also helps prevent the infections that often accompany early-stage surfer’s ear, though it won’t stop the bone growth itself.
When Surgery Becomes Necessary
Surfer’s ear only requires surgery when the growths are large enough to cause persistent hearing loss or recurring infections that won’t respond to standard treatment. Many surfers live with mild to moderate exostoses and never need intervention. The decision typically comes down to quality of life: if you’re getting frequent infections, losing hearing, or constantly dealing with trapped water that won’t clear, surgery becomes worth considering.
The procedure, called an exostectomy, involves removing the bony growths to reopen the ear canal. Surgeons use one of two main techniques, and each involves trade-offs. The chisel (osteotome) method uses a small surgical tool to chip away the bone. A 2023 meta-analysis found this approach carries a higher risk of eardrum perforation (about 5.3%) but a lower risk of permanent hearing damage (under 1%). The drill method uses a high-speed surgical drill for more precise bone removal but transmits vibration directly to the inner ear structures, resulting in a higher rate of lasting hearing changes (about 4.3%) and post-surgical narrowing of the canal (about 4.1%). Some surgeons combine both techniques, using the chisel for bulk removal and the drill for fine work, to balance precision with safety.
Recovery takes longer than most people expect. You’ll need at least two weeks off work, and the ear canal requires roughly six weeks to heal before any water exposure. That means no surfing, swimming, or even getting the ear wet in the shower during that entire period. Some people need longer depending on how quickly their canal heals.
Regrowth After Surgery
One important reality: surgery removes the existing growths, but it doesn’t change your ear’s tendency to produce them. If you return to cold water without ear protection, the bone will start growing again. The timeline will vary, but the same 10-12% annual increase in risk applies. This is why surgeons strongly emphasize wearing earplugs after the procedure. Surgery buys you a reset, but prevention is what keeps the canal open long-term.