CLINICAL CASES
CLINICAL CASES
Using the Wispr Digital Otoscope
50-year-old Scuba Diver
During a presentation at a leading children’s academic medical center, the following image was obtained using the Wispr digital otoscope. The individual noted that he has a history of scuba diving. He has no hearing complaints.
Which of the following is likely true?
A. He has a history of tympanic membrane (TM) perforations.
B. He has a history of frequent exposure to cold water.
C. He has a history of ear infections.
D. He has a history of middle ear effusions (MEE).
Answer: B. He has a history of frequent exposure to cold water.
The individual has exostosis. This is a benign overgrowth of the bone in the ear canal. Frequent exposure to cold water is thought to stimulate osteoblasts, causing the bony overgrowth. The tympanic membrane is not well-visualized, but there is no indication of a perforation. Similarly, there is no indication of prior infections (acute otitis media, AOM) or a middle ear effusion (MEE). Exostosis does not require treatment unless it becomes so severe that it blocks the ear canal, causing either hearing loss or susceptibility to infection.
In addition, the patient has what appears to be an osteoma (but may be another exostosis). Osteomas tend to have a pedunculated base. The two growths can be difficult to distinguish in mild cases by appearance alone. However, they are histologically distinct, with exostoses having a laminated appearance representing layers of newly formed bone. This is believed to occur when repeated exposure to cold water triggers periostitis resulting in sequential episodes of osteogenesis, giving rise to the term “surfer’s ear.” Osteomas arise from cancellous bone and lack the layered growth pattern of exostoses. Both lesions are generally asymptomatic unless they enlarge enough to cause conductive hearing loss. In these instances, referral to otolaryngology (ENT) is warranted for further evaluation and potential surgical removal.
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