What do windsurfers and kitesurfers in Germany know about surfer's ear and how is it influenced by protective measures?

OBJECTIVE: This study investigated the frequency of ear canal protection use and looked at its influence on external auditory exostosis severity and knowledge about external auditory exostosis among windsurfers and kitesurfers on the German coast. METHOD: This retrospective cross-sectional study interviewed 130 windsurfers and kitesurfers along the German coast on knowledge of external auditory exostosis, exposure time, use of neoprene hoods and earplugs, and otological complaints. Participants underwent bilateral video-otoscopic examination. RESULTS: Knowledge of external auditory exostosis was 'good' or 'excellent' in 78 of 130 (60 per cent) individuals and 'poor' or non-existent in 52 of 130 (40 per cent) individuals. Knowledge was positively correlated with hours of exposure, otological complaints and frequency of ear canal protection use. A significant negative influence of neoprene hood use on external auditory exostosis severity was shown. CONCLUSION: The positive effect of external auditory exostosis knowledge on the frequency of ear canal protection and the reduction of external auditory exostosis risk implies a need for health education on this topic.

External auditory exostosis among surfers: a comprehensive and systematic review.

OBJECTIVE: External auditive exostosis (EAE), known as surfer's ear, is a temporal bone outgrowth resulting from ear exposure to cold air and water. This review aims to shed light on the prevalence of EAE among worldwide surfers. METHODS: By a thorough retrieval of the PubMed, we found all original investigations performed on EAE among suffers. The retrieval time was from the construction of the database to December 2022. Agency for Healthcare Research and Quality (AHRQ) methodology checklist for assessing the quality of cross-sectional/prevalence study was performed. RESULTS: 19 articles were selected involving 2997 surfers on whom 2032 presented EAE. The prevalence of EAE was ranged from 53 to 90% with a mean at 67.8%. 3 investigations were performed from USA, five from UK and Ireland, five from Australia and New Zealand and six from Japan and Europe. CONCLUSION: Cold water exposure, combined with wind and prolonged surfing activity, contributes to the development of EAE. Symptoms range from mild discomfort to hearing loss and recurrent infections. Preventive measures, such as raising awareness and promoting the use of ear protection, are crucial. Further research is needed to improve prevention strategies and understand the underlying mechanisms of EAE.

Prevalencia de la exóstosis del conducto auditivo externo entre practicantes de surf y bodyboard en la costa central de Chile / Prevalence of auditory canal exostosis among surfers and bodyboarding athletes of the central Chilean coast

La exóstosis del conducto auditivo externo (ECAE), también conocida como oído de surfista, es una alteración del tejido óseo del oído externo, principalmente causada debido a la sobrexposición al frío. Considerando que los practicantes de deportes acuáticos como el surf y bodyboard de las costas del pacífico sur se exponen a aguas con temperaturas entre 12-16 °C, se busca determinar, en este estudio, la prevalencia y grado de ECAE en practicantes de surf y bodyboard de las localidades de Reñaca y Concón durante el año 2018. Se realizó una evaluación del CAE mediante video-otoscopía a 67 personas (134 oídos) practicantes de surf y bodyboard de las playas de Reñaca y Concón, y se les aplicó un cuestionario respecto a sus hábitos de práctica. Como resultado, se observó una prevalencia de ECAE del 77,6%, siendo el 61,2% ECAE bilateral y el 16,4% ECAE unilateral. Se pudo determinar, además, que el 62,3%de los participantes no usa protecciones. A partir de estos hallazgos, es posible concluir que existe una alta prevalencia de la ECAE en practicantes de surf y bodyboard en las costas centrales chilenas, lo que debería alertar tanto a la población practicante como a profesionales de la salud auditiva con el fin de promover una vida saludable en esta población.

External auditory canal exostosis (ECAE), also known as surfer's ear, is an alteration of the bone tissue of the external ear, mainly caused due to overexposure to cold. Considering that those who practice water sports such as surfing and bodyboarding on the Pacific coast are exposed to waters with temperatures between 12-16 °C,. We seek to determine, in this study, the prevalence and degree of ECAE in surfers and bodyboarders from the coast of the south of Pacific Ocean, Reñaca and Concón, during the year 2018. An evaluation of the ECAE was carried out by means of video-otoscopy in 67 people (134 ears) who practiced surfing and bodyboarding from the beaches of Reñaca and Concón, and a questionnaire was used to collect information about their practice habits. As a result, a prevalence of ECAE of 77.6% was observed, with 61.2% bilateral ECAE and 16.4% unilateral ECAE. It was also possible to determine that 62.3% of the participants do not use protections. Based on these findings, it is possible to conclude that there is a high prevalence of ECAE in surfers and bodyboarders on the central Chilean coasts, which should alert both the practicing population and hearing health professionals to promote a healthy life in this population.

Prevention of external auditory canal exostosis in the Colorado whitewater community.

CONTEXT: External auditory canal exostoses (EACE) are bony formations that develop insidiously in the auditory meatus from chronic exposure to cold water and, in severe cases, require surgery. This condition has been understudied in the whitewater kayakers and not yet studied in the riverboarding population. Precautions such as earplugs are thought to prevent the formation of EACE because they mechanically block cold water from contacting the sensitive skin in the external auditory canal; however, earplugs are not commonly utilized by athletes. Inquiring about hobbies and the use of protective equipment can be done during osteopathic physicians' preventive care visits. OBJECTIVES: This article aims to determine the prevalence of EACE in Colorado whitewater athletes and their attitudes about wearing ear protection before and after an educational intervention directed at increasing awareness and prevention of EACE. METHODS: In July 2020, participants of this cross-sectional study completed a 10-min survey that collected demographics, whitewater experience, and perceptions of EACE, followed by an educational intervention. Participant ears were photographed utilizing a digital otoscope to assess EACE, and severity ratings were categorized into one of four occlusion levels: none (0%), mild (<25%), moderate (25-75%), or severe (>75%). Spearman correlation coefficients and Wilcoxon signed-rank tests were utilized to assess changes in attitudes before and after the educational intervention. RESULTS: Eighty-one participants (mean [SD] age = 36.3 [12.6] years, 25.9% female) completed the study: 74 kayakers and seven riverboarders. After the intervention, 60.5% (49/81) (p<0.001) reported greater understanding of EACE and 75.0% (60/80) were more likely to wear ear protection (p<0.001). Most (58.0%, 47/81) never wore ear protection. Of the 61 (75.0%) participants with at least one ear severity rating, most (55.7%, 34/61) had moderate EACE, 29.5% (18/61) had no to mild EACE, and 14.8% (9/61) had severe EACE (p<0.001). Impaired hearing was the biggest barrier to utilizing ear protection (51.6%, 33/64). CONCLUSIONS: Our results suggested that the educational intervention improved understanding of EACE and may increase utilization of ear protection in this population. Such prevention efforts may lead to better health of whitewater paddlers by reducing the incidence of EACE. Encouraging osteopathic physicians to inquire about hobbies and protective equipment during primary care preventive visits is essential to help keep athletes in the river doing what they love for longer, contributing to a healthier and happier whole person.

Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears.

PURPOSE: The aim of the study was to investigate the efficacy of ear protection (earplug and surf hood) in preventing the development of external auditory exostosis (EAE) in surfers. METHODS: We performed a prospective observational study. Volunteer surfers were recruited from June 2016 to October 2017 on the Brittany coast in France. Each participant filled in a questionnaire and underwent otoscopic digitalized photography to establish the degree of external ear obstruction by two different practitioners. The correlation between the percentage of external ear obstruction and the time spent in water with or without protection was evaluated. Risk factors of EAE were assessed. RESULTS: Two hundred and forty-two ears were analysed. The incidence of EAE was 89.96% with an average rate of obstruction of 37.65%. Risk factors for EAE were male sex (p = 0.0005), number of years practicing surf (p < 0.0001) and symptoms of ear obstruction (p = 0.0358). A significant correlation was found between EAE severity and number of hours spent in water without any protection (earplugs or surf hood) (p < 0.0001). No correlation was found between EAE severity and time spent in water with earplugs (p = 0.6711) but a correlation was identified between obstruction and time spent in water with surf hood (p = 0.0358). CONCLUSIONS: Wearing earplugs is an effective way to prevent EAE in surfers unlike surf hood.

Awareness and attitudes towards external auditory canal exostosis and its preventability in surfers in the UK: cross-sectional study.

OBJECTIVES: To determine the proportion of UK surfers aware of external auditory canal exostosis, to identify surfer characteristics associated with knowledge of the condition and to explore attitudes to earplug use. METHOD: An online, cross-sectional survey of UK-based surfers. RESULTS: Of 375 surfers, 86.1 per cent (n = 323; 95 per cent confidence interval = 82.3-89.3) reported awareness of external auditory canal exostosis. Further investigation revealed that, despite their awareness of the condition, 23.4 per cent of these surfers (88 out of 323; 95 per cent confidence interval = 19.5-28.0) had little or no knowledge about external auditory canal exostosis. Predictors of knowledge included: distance from nearest surfing beach (p = 0.001), surfing standard (ability) (p = 0.008), earplug use (p = 0.024) and positive external auditory canal exostosis diagnosis (p = 0.009). CONCLUSION: The findings suggest that a significant minority of UK surfers have no knowledge about this condition. Knowledge of external auditory canal exostosis was significantly associated with earplug use when surfing. Efforts to improve surfers' knowledge are required to enable surfers to better protect themselves, which could reduce the incidence of external auditory canal exostosis.

The effects of surfing behaviour on the development of external auditory canal exostosis.

To examine how individual surfing behaviour affects the development of external auditory canal exostosis and to produce a model to predict exostosis severity. A standardised questionnaire was completed and each participant underwent an otoscopic examination. Surfers were recruited from August to October 2011 from surfing competitions and from colleges in the South West of England. 207 surfers were included, 53 % had evidence of external auditory canal; exostosis: grade 1, 23%; grade 2, 16%, grade 3, 16%. This risk of exostosis significantly increased with (1) surfing for 6 or more years, (2) surfing in the winter months, (3) surfing five or more times per month in the winter and (4) reported ear symptoms. Interestingly, participation in other water sports and wearing earplugs or a hood reduced the risk of developing exostosis. Surfers who surf in England are at significant risk of exostosis. A probability model was designed, incorporating different surfing behaviours and ear symptoms, the first of its kind in exostosis research. This model will be a useful tool for raising awareness of external ear canal exostosis in the surfing community and in assessing individual need for surgical intervention.

Audiological implications of earplugs used for the prevention of aural exostoses.

External auditory canal exostoses may be a preventable disease, so it is surprising that the regular use of water precautions is not greater among surfers. One reason for this is the impairment of hearing whilst wearing earplugs. The objective of this study is to establish the hearing impairment of commonly available earplugs used by surfers. Staff and patients with normal hearing were recruited to have pure tone audiometry performed multiple times, initially with no earplugs, and subsequently with earplugs. Three earplug types were tested which differed in their nature and material (prefabricated elastomer, custom-fitted silicone, and custom-fitted acrylic). Vented and non-vented forms of the earplugs were tested. 30 normal hearing ears were included. Two-tailed paired t-tests comparing hearing thresholds between different earplugs identified that the elastomer earplugs caused the least hearing impairment (p < 0.001). There was no significant difference in hearing thresholds between vented and non-vented elastomer earplugs (p = 0.148), but the difference between vented and non-vented forms of other earplugs was statistically significant (silicone p = 0.010, acrylic p = 0.018). Prefabricated ear plugs produce less hearing impairment than other commonly available earplugs. A customised earplug made of hard material causes the greatest impairment of hearing. We therefore recommend that for aquatic sports where hearing is important, a soft prefabricated earplug is preferable.

Surfers' awareness of the preventability of 'surfer's ear' and use of water precautions.

OBJECTIVE: To establish surfers' knowledge of the preventability of external auditory canal exostoses ('surfer's ear'), and their use of water precautions. METHOD: Survey of surfers conducted between December 2009 and March 2010 at beaches in Cornwall, UK. RESULTS: Ninety-two surfers were included (78 males and 14 females, mean age 27 years, standard deviation 7.9 years). Participants were grouped according to their awareness of the preventability of surfer's ear (55 aware, 37 unaware). These groups were comparable in age, surfing history and gender mix (p > 0.05). Surfers aware of the preventability of exostoses (66 per cent) were more likely to use water precautions than those who were not (38 per cent) (p < 0.01). Two surfers used water precautions regularly and 48 used them occasionally. Sixty-one of the 76 surfers who did not use water precautions (ear plugs) suggested they would consider doing so in the future. CONCLUSION: Awareness of the preventability of surfer's ear was associated with greater use of water precautions. Further research should explore reasons for the low uptake of such precautions. Most surfers not already using ear plugs would consider doing so in the future.

Exploraciones otorrinolaringológicas recomendables previas al inicio de actividades subacuáticas o aeronáuticas. Legislación vigente / Recommended otorhinolaryngological examination prior to diving or flying. Current legislation

Introducción, objetivos y métodos: El organismo humano está relativamente bien adaptado a los cambios de presión a los que se somete durante las actividades aeronáuticas e, incluso, las subacuáticas. Pequeñas alteraciones anatómicas o funcionales que no constituyen un problema a una presión atmosférica habitual, pueden originar complicaciones al someter al organismo a medios hipobáricoshiperbáricos. El objetivo de este capítulo es hacer una revisión de los criterios de aptitud en la legislación vigente, valorar las contraindicaciones para la práctica de buceo o actividades aeronáuticas y repasar las exploraciones necesarias en el área otorrinolaringológica (ORL) que permitan detectar procesos patológicos. Resultados: La valoración anatómica y funcional ORL nos permite descartar candidatos con distintas alteraciones que contraindican la práctica de estas actividades. No está tan claro cómo explorar las alteraciones funcionales y si hay relación entre los hallazgos y la posibilidad de aparición de complicaciones. La legislación vigente es poco clara en las actividades subacuáticas. Contraindica la actividad en personas con afectaciones que pruebas científicas recientes muestran que podrían ser aptas. La legislación en cuanto a pilotos y tripulantes de cabina de pasajeros de aeronaves comerciales estipula perfectamente las revisiones que se deben realizar, así como las contraindicaciones para la concesión de certificados de aptitud. Conclusiones: Es necesario realizar reconocimientos médicos en las personas que se someten a cambios de presión. En el área ORL, las exploraciones permiten hacer una buena valoración de los posibles problemas que pueden aparecer en los distintos candidatos (AU)

Introduction, objectives and methods. The human body is relatively well adapted to the pressure changes experienced during flying and even diving. Small anatomical or functional alterations that would not cause problems at a normal atmospheric pressure can cause complications when the body is subjected to hypobaric-hyperbaric environments. The present article aims to provide a review of the criteria for fitness to dive or fly according to current legislation, to evaluate the contraindications for the practice of diving or flying, and to describe the otorhinolaryngological (ORL) examinations that allow abnormalities to be detected. Results. Anatomical and functional ORL examination allows candidates with various alterations that contraindicate the practice of these activities to be excluded. Less clear are the methods for examining functional alterations and whether there is a relationship between these findings and the possible development of complications. Current legislation on diving is unclear. Subaquatic activities are contraindicated in persons with certain alterations, although recent scientific tests show that they may be fit to dive. Legislation on the pilots and cabin crews of commercial airplanes stipulate the examinations that should be performed as well as the contraindications for issuing certificates of fitness to fly. Conclusions. Medical examinations should be performed in persons undergoing changes in atmospheric pressure. ORL examinations allow the possible problems that may develop in distinct candidates to be thoroughly evaluated (AU)

Enfermedades del oído externo y la articulación temporomandibular en el buceo / Alterations of the external ear and temporomandibular joint in diving

La práctica del buceo ha experimentado un notable crecimiento en las últimas décadas. Una amplia mayoría de las enfermedades asociadas con ella están relacionadas con el área de la cabeza y el cuello, por lo que un otorrinolaringólogo debe conocer los problemas que un buceador puede experimentar. En el oído externo destacan enfermedades como la otitis externa difusa, los barotraumatismos y la exostosis. También, con alta prevalencia, se presenta en los buceadores el síndrome de disfunción de la articulación temporomandibular (AU)

The practice of diving has experienced marked growth in the last few decades. Most of the disorders associated with this activity are related to the head and neck and consequently otorhinolaryngologists should be familiar with the problems that divers can experience. Notable among disorders of the external ear are diffuse otitis externa, barotrauma, and exostosis. Temporomandibular joint dysfunction syndrome is also highly prevalent among divers (AU)

[Anterior intertrochanteric ossification after total hip arthroplasty]. / Die anteriore intertrochantäre Ossifikation nach Hüfttotalendoprothesenimplantation.

AIM: Heterotopic paraarticular ossifications are usually identified by an anterior-posterior radiograph of the corresponding hip and are consecutively classified by the well accepted methods of Brooker, Arcq or deLee. In these methods ossifications are solely evaluated by the means of a single a-p radiograph, hence a major part of ossifications located in the anterior intertrochanteric region cannot be evaluated. Our study deals with the incidence of ossifications exclusively verifiable by an axial radiograph. METHOD: In the present study 209 patients' axial radiographs were retrospectively analysed by using our simple method of classification. In the axial projection these ossifications are situated anterior of the intertrochanteric region, therefore we created the term "anterior intertrochanteric ossification (AIO)". After developing a simple topographic scheme we classified these appearances by localisation and size. RESULTS: After total hip arthroplasty by using the transgluteal approach ossifications situated in the anterior intertrochanteric region can develop. These ossifications appear as bone islands, shield or clip like (without fixed connection to the femoral cortical bone) or as solid exostoses. Due to their strict anterior localisation these formations are often solely verifiable by the means of an axial (Lauenstein) radiograph. We were able to identify anterior intertrochanteric ossifications (AIO) in 97 out of 209 patients (48.4 %), 27 patients (13 %) developing an anterior intertrochanteric ossification were classified grade 0 according to the methods of Brooker, Arcq and deLee. CONCLUSION: According to the widely accepted methods of classification of paraarticular ossifications depending on a single a-p radiograph of the corresponding hip, 13 % of paraarticular ossifications would remain undocumented because of their strict anterior intertrochanteric position.

Exostoses of the external auditory canal in Oregon surfers.

PURPOSE: The objectives of this study were to determine the cold water exposure necessary to produce exostoses of the external auditory canal in individuals who predominantly surf along the Oregon and/or the northern California coastline and to ascertain from surfers' otologic histories symptoms attributable to exostoses. MATERIALS AND METHODS: Free ear examinations were provided at two surf shops in northern Oregon. The ear canals were examined with an otoscope, and each surfer was given a summary score indicating the percentage of both canals that was obstructed by exostoses. Surfers were then categorized according to the number of years surfing and the number of sessions surfing per year. RESULTS: Twenty-one surfers met our criteria for analysis. The degree of ear canal obstruction significantly increased with increasing number of years surfing (P < .001) and with increasing number of sessions surfing per year (P < .01). The median summary scores were 7.5, 63.0, and 93.0 for individuals who respectively surfed between 1 and 5 years, between 6 and 15 years, and greater than 15 years. The median summary scores were 10.0 for individuals who surfed 50 sessions or less per year versus 87.5 for individuals who surfed greater than 50 sessions per year. Most surfers with exostoses had minimal complaints. Only one patient had a history of surgical treatment. CONCLUSION: Individuals who surf 5 years or less are unlikely to develop exostoses unless they are surfing greater than 50 sessions per year. Exostoses are typically a benign malady that do not require surgical therapy.