To drill or to chisel? A long-term follow-up study of 92 exostectomy procedures in the UK.

INTRODUCTION Recent innovation in wetsuit technology has opened the way for year-round surfing/water sport along the UK coast. Resulting exposure to low water temperatures combined with wind chill have been associated with external auditory canal (EAC) exostosis, also known as “surfers’ ear.” This condition is characterized by multiple, bilateral outgrowths of temporal bone (Fig. 1) into the EAC. The main indication for exostectomy is recurrent otitis externa. These infections can be difficult to treat because the narrowed canal prevents optimal penetration of topical antimicrobials and effective microsuction. Exostosis surgery has been performed for over a hundred years with both drill and chisel. Drilling is considered to be more precise and reduces the risk of inadvertent injury to surrounding structures, whereas chiseling cleaves along natural planes in the bone. Chiseling also avoids the risks of tinnitus and sensorineural hearing loss, which may be associated with the direct transmission of sound energy to the cochlear through the canal wall when drilling.