Correction of exostoses

PLEASE NOTE - THIS INFORMATION IS INTENDED FOR GUIDANCE ONLY. IT IS NOT IN ANY WAY A SUBSTITUTE FOR A SPECIALIST CONSULTATION.

Why is correction of exostoses carried out?

Exostoses are bony outgrowths in the ear canal that tend to occur in swimmers, surfers, windsurfers and other watersports enthusiasts. Most don't cause any problems, but sometimes they can cause a feeling of blockage in the ear, problems with a build up of wax or repeated infections. Often ear plugs, or regular cleaning of the ear in out-patients are enough to stop these problems from happening, but sometimes it is necessary to remove them surgically.

Are there any alternatives to surgery?

The exostoses grow as a result of cold water getting in the ears. Wearing ear plugs for watersports (usually custom-fitted ones are best) may be enough to stop the exostoses from growing further. They may also stop infections, which generally occur after water has got into the ears.

If the problem is with wax build-up, regular cleaning of the ears in out-patients may help. We do not recommend that patients with significant exostoses have their ears syringed at their GP surgery.

How is the surgery performed?

The operation is carried out under general anaesthetic (you are completely asleep).

We carry out this sort of surgery via a scar behind the ear. The skin over the exostoses is carefully protected and the bone is removed, using an operating microscope and a specially designed surgical drill.

We generally aim to make the ear canal as wide as or wider than it would have been originally.

The scar is closed with dissolving stitches buried under the skin and a dressing or "pack" is placed in the ear canal.

What can I expect after the surgery?

You will probably have a bandage around your head when you wake up. This is to reduce the risk of bleeding or extensive bruising.

The bandage will be removed before you go home. If your operation is in the morning you will normally have the bandage removed and be allowed home after 6 hours if you are well enough. If your operation is in the afternoon it is likely you will need to stay overnight.

You will be given some pain relief to take home.

Because the sutures are dissolving and buried under the skin you will not need to have any sutures removed.

While the pack is in place, the hearing in that ear will be reduced. The pack will be removed at your out-patients appointment 2 weeks after the operation. You will normally be given a one week course of antibiotic ear drops to use after the pack has been removed.

The pack is important because it holds the ear canal skin back in place and stops the ear canal from narrowing down as a result of scarring. If the pack falls out within the first 10 days after the operation it is important that you get in contact, either via the ward or the appropriate secretary, as it may need replacing. The pack looks like a short piece of crumpled ribbon and may be yellow or brown.

You may get small amounts of discharge or bleeding from the ear during the healing process, and this is generally nothing to worry about. However if there is a lot of discharge or if it starts to smell offensive  you may have an infection and should either consult your GP or get back in contact directly.

Similarly if the wound or external ear start to look red you should seek medical advice.

You should plan to take 2 weeks off work following the operation. There is some flexibility in this. If you have a sedentary job or can work from home you may be able to return to work sooner if you wish, but if you have a physically demanding job you may need a little longer. We will, of course, be happy to discuss this with you.

You will need to keep all water out of your ear following the surgery. We generally recommend that you make plans to avoid all watersports for 3 months. This is an average - some patients will have healed up well before this, some may take longer.

What are the risks of the surgery?

All operations, however carefully and expertly they are carried out, have risks attached.

Whilst we always do our best to operate only when we think there is a good chance of the surgery being successful, there is always a chance that the symptoms we are trying to treat may not improve following the operation.

As with almost any operation there is a small risk of post-operative infection, bleeding or bruising, and a chance that the scar will be noticeable or not heal properly.

With a scar behind your ear you may notice some numbness of the top part of the ear. This will almost certainly settle down with time, but may take a few months to settle completely.

The exostoses often sit very close to, or touching, the ear drum. Although we take every care to avoid it, there is a very small risk of damaging the ear drum. If this were to occur we would almost certainly repair it there and then, but there is a small chance that further surgery would be needed if the drum didn't heal.

The jaw joint (temporomandibular joint) is just in front of the ear canal. Very occasionally widening out the ear canal can weaken the bone between the jaw joint and ear canal, causing some pain or discomfort on chewing or yawning.

The nerve that moves the muscles on that side of your face passes through the mastoid bone, very close to where we are operating. We are always extremely careful of this nerve and use special monitoring equipment during the surgery to make sure the nerve isn't being damaged (you may notice some tiny pinpricks in your face from the monitoring equipment after the operation). Nonetheless there is a very small risk of this nerve being damaged. The effects of this could range from a mild weakness of one side of the face that improves on its own in a few weeks to, in the worst case, a complete permanent paralysis of one side of the face. Any sort of facial weakness following exostosis surgery is, however, extremely rare.

There is a very small risk of the hearing getting worse as a result of the surgery, and a tiny risk of complete hearing loss in that ear. The hearing in the other ear would, of course, be unaffected.

Hearing and balance are very closely related, and there is also a very small chance of some dizziness or loss of balance following the surgery. If this were to occur it would be almost certainly be temporary.

There is also a small risk of developing some tinnitus (noises in the ear), but again this would be likely to settle down quite quickly.

If you continue to participate in watersports without using ear plugs after the ear has healed, there is a good chance that the exostoses will return, although it may be many years before they cause any problems again.