Lifetime prevalence of exostoses in New Zealand surfers
Vini Simas 1 6 , Debbie Remnant 2 , James Furness 1 , Catherine J. Bacon 2 3 , Robert W. Moran 2 , Wayne A. Hing 1 , Mike Climstein 1 4 51 Water Based Research Unit, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
2 Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
3 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
4 School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
5 Exercise Health & Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
6 Corresponding author. Email: Vsimas@bond.edu.au
Journal of Primary Health Care 11(1) 47-53 https://doi.org/10.1071/HC18097
Published: 3 April 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: External auditory exostosis (EAE) is a benign, irreversible bony outgrowth that arises from the temporal bone. EAE projects into the external ear canal, potentially causing recurrent otitis externa and conductive hearing loss.
AIM: To determine lifetime prevalence of EAE in New Zealand (NZ) surfers.
METHODS: This study used an online national survey.
RESULTS: Respondents were 1376 NZ surfers (recreational = 868, competitive = 508). Mean surfing experience was 16.2 years. Most self-classified as advanced surfers (36.5%), followed by intermediate (30.2%), expert (20.1%) and beginner (13.2%). Surfers reported an average of 214.2 h surfing (28.6% during winter) for the previous year. Overall lifetime prevalence of EAE was 28.9% (32.1% male, 14.6% female; P < 0.001), with the highest proportion of EAE was observed bilaterally (21.3%). Competitive surfers reported a significantly (P < 0.001) higher lifetime prevalence of EAE than recreational surfers (45.3% vs. 19.2%). A significantly higher (P < 0.001) lifetime prevalence of EAE was identified as skill level increased (7.1% in beginners to 55.6% in experts) and a two-fold increase (P < 0.001) of EAE in the highest (vs. lowest) quartile of surfing exposure. Neither winter surfing exposure nor which Island surfed were associated with EAE prevalence.
DISCUSSION: Although not as prevalent as in previous NZ research using otologic examinations, this study indicated that almost one-third of NZ surfers reported having had a diagnosis of EAE. Regular general practitioner otologic assessment and advice on appropriate prevention strategies for patients who surf may help prevent large lesions, recurrent ear infections and progressive hearing loss.
KEYWORDS: Auditory exostoses; surfing; surfer’s ear; otology; preventive medicine; sports medicine
References
[1] Simas V, Furness J, Hing W, et al. Ear discomfort in a competitive surfer. Aust Fam Physician. 2016; 45 644–6.| 27606365PubMed |
[2] Kroon DF, Lawson ML, Derkay CS, et al. Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngol Head Neck Surg. 2002; 126 499–504.
| Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers.Crossref | GoogleScholarGoogle Scholar | 12075223PubMed |
[3] Umeda Y, Nakajima M, Yoshioka H. Surfer’s ear in Japan. Laryngoscope. 1989; 99 639–41.
| 2725159PubMed |
[4] Hurst W. A review of 64 operations for removal of exostoses of the external ear canal. Aust J Otolaryngol. 2018; 4 187–90.
[5] Timofeev I, Notkina N, Smith IM. Exostoses of the external auditory canal: a long-term follow-up study of surgical treatment. Clin Otolaryngol Allied Sci. 2004; 29 588–94.
| Exostoses of the external auditory canal: a long-term follow-up study of surgical treatment.Crossref | GoogleScholarGoogle Scholar | 15533142PubMed |
[6] Reddy VM, Abdelrahman T, Lau A, Flanagan PM. Surfers’ awareness of the preventability of ‘surfer’s ear’ and use of water precautions. J Laryngol Otol. 2011; 125 551–3.
| Surfers’ awareness of the preventability of ‘surfer’s ear’ and use of water precautions.Crossref | GoogleScholarGoogle Scholar | 21310100PubMed |
[7] American Academy of Family Physicians Information from your family doctor. Safe surfing. Am Fam Physician. 2005; 71 2319–20.
| 15999869PubMed |
[8] Harrison DF. The relationship of osteomata of the external auditory meatus to swimming. Ann R Coll Surg Engl. 1962; 31 187–201.
| 13904891PubMed |
[9] Attlmayr B, Smith IM. Prevalence of ‘surfer’s ear’ in Cornish surfers. J Laryngol Otol. 2015; 129 440–4.
| Prevalence of ‘surfer’s ear’ in Cornish surfers.Crossref | GoogleScholarGoogle Scholar | 25772761PubMed |
[10] Deleyiannis FW, Cockcroft BD, Pinczower EF. Exostoses of the external auditory canal in Oregon surfers. Am J Otolaryngol. 1996; 17 303–7.
| Exostoses of the external auditory canal in Oregon surfers.Crossref | GoogleScholarGoogle Scholar | 8870934PubMed |
[11] Alexander V, Lau A, Beaumont E, Hope A. The effects of surfing behaviour on the development of external auditory canal exostosis. Eur Arch Otorhinolaryngol. 2015; 272 1643–9.
| The effects of surfing behaviour on the development of external auditory canal exostosis.Crossref | GoogleScholarGoogle Scholar | 24619201PubMed |
[12] Garner D. The seasonal range of sea temperature on the New Zealand shelf. New Zeal J Mar Fresh. 1969; 3 201–8.
| The seasonal range of sea temperature on the New Zealand shelf.Crossref | GoogleScholarGoogle Scholar |
[13] Stats NZ Tatauranga Aotearoa. New Zealand’s Environmental Reporting Series: Environmental indicators Te taiao Aotearoa 2018. [cited 2018 November 12]. Available from: http://archive.stats.govt.nz/browse_for_stats/environment/environmental-reporting-series/environmental-indicators/Home/Marine/coastal-sea-surface-temperature.aspx
[14] New Zealand Sea Temperatures. New Zealand Sea Temperatures. 2018. Available from: https://www.seatemperature.org/australia-pacific/new-zealand/
[15] Wong BJF, Cervantes W, Doyle KJ, et al. Prevalence of external auditory canal exostoses in surfers. Arch Otolaryngol Head Neck Surg. 1999; 125 969–72.
| Prevalence of external auditory canal exostoses in surfers.Crossref | GoogleScholarGoogle Scholar |
[16] Altuna Mariezkurrena X, Gomez Suarez J, Luqui Albisua I, et al. Prevalence of exostoses among surfers of the Basque Coast. Acta Otorrinolaringol Esp. 2004; 55 364–8.
| Prevalence of exostoses among surfers of the Basque Coast.Crossref | GoogleScholarGoogle Scholar | 15552211PubMed |
[17] Chaplin JM, Stewart IA. The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol Allied Sci. 1998; 23 326–30.
| The prevalence of exostoses in the external auditory meatus of surfers.Crossref | GoogleScholarGoogle Scholar | 9762494PubMed |
[18] Brocklesby J. Active NZ 2017 Participation Report, 2018. Available from: https://sportnz.org.nz/assets/Uploads/Main-Report.pdf
[19] Aotearoa SNT. National population estimates (at 30 June 2018). 2018. Available from: https://www.stats.govt.nz/information-releases/national-population-estimates-at-30-june-2018
[20] Sport New Zealand. Sport and Recreation Participation Trends (1997 to 2007). 2018. Available from: https://www.srknowledge.org.nz/research-completed/sport-and-recreation-participation-trends-1997-2007/
[21] Furness J, Hing W, Walsh J, et al. Acute injuries in recreational and competitive surfers: incidence, severity, location, type, and mechanism. Am J Sports Med. 2015; 43 1246–54.
| Acute injuries in recreational and competitive surfers: incidence, severity, location, type, and mechanism.Crossref | GoogleScholarGoogle Scholar | 25646362PubMed |
[22] Hutt A, Black K, Mead T. Classification of surf breaks in relation to surfing skill. J Coast Res. 2001; 29 66–81.
[23] Statistics New Zealand. 2013 Census – Major ethnic groups in New Zealand. 2013. Available from: http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/infographic-culture-identity.aspx.
[24] Pickrill R, Mitchell J. Ocean wave characteristics around New Zealand. New Zeal J Mar Fresh. 1979; 13 501–20.
| Ocean wave characteristics around New Zealand.Crossref | GoogleScholarGoogle Scholar |
[25] Toynbee J. On osseous tumours growing from the walls of the Meatus Externus of the ear: and on the enlargement of the walls themselves; with Cases. Prov Med Surg J. 1849; 13 533–7.
| 20794716PubMed |
[26] Field G. Case of ivory exostosis in both ears. Lancet 1878; 112 81
| Case of ivory exostosis in both ears.Crossref | GoogleScholarGoogle Scholar |
[27] Kennedy GE. The relationship between auditory exostoses and cold water: a latitudinal analysis. Am J Phys Anthropol. 1986; 71 401–15.
| The relationship between auditory exostoses and cold water: a latitudinal analysis.Crossref | GoogleScholarGoogle Scholar | 3812656PubMed |
[28] New Zealand Latitude and Longitude Map. 2018 . Available from https://www.mapsofworld.com/lat_long/newzealand-lat-long.html
[29] Cooper A, Tong R, Neil R, et al. External auditory canal exostoses in white water kayakers. Br J Sports Med. 2010; 44 144–7.
| External auditory canal exostoses in white water kayakers.Crossref | GoogleScholarGoogle Scholar | 18603582PubMed |
[30] Lau A, Alexander V, Williams R, et al. External auditory canal exostosis (EACE) in English cold water surfers: prevalence, risk factors and grading. Clin Otolaryngol. 2012; 37 139
[31] Furness J, Hing WA, Abbott A, et al. Retrospective analysis of chronic injuries in recreational and competitive surfers: injury location, type, and mechanism. Int J Aquat Res Educ. 2014; 8 277–87.
| Retrospective analysis of chronic injuries in recreational and competitive surfers: injury location, type, and mechanism.Crossref | GoogleScholarGoogle Scholar |
[32] Hurst W, Bailey M, Hurst B. Prevalence of external auditory canal exostoses in Australian surfboard riders. J Laryngol Otol. 2004; 118 348–51.
| Prevalence of external auditory canal exostoses in Australian surfboard riders.Crossref | GoogleScholarGoogle Scholar | 15165308PubMed |