External Auditory Canal Exostosis and the California Surfer Population: A Cross-Sectional Study

California has the most surfers in the United States and a high prevalence of external auditory canal exostoses (EACEs) among them. We aimed to characterize their EACE knowledge, use of earplugs, and barriers toward earplug use.

A RedCap survey was distributed to online surfing forums and surfers at California beaches. Descriptive statistics and regression analyses were used to characterize responses.

Our cohort included 334 primarily male (n = 269, 81.52%), college-educated (n = 237, 71.17%) surfers who were on average 30.79 years old (SD = 11.07). Two hundred and ninety-seven (90.00%) heard of EACE and 317 (96.06%) believed earplugs prevent EACE. However, 214 (64.85%) had never used earplugs. Multivariable logistic regression found increased age (OR = 1.04, 95% CI = [1.00-1.08], p = 0.03), higher EACE knowledge quiz scores (OR = 1.47, 95% CI = [1.19-1.80], p < 0.001), and primarily surfing in Southern California (OR = 2.19, 95% CI = [1.15-4.16], p = 0.02) increased the likelihood of earplug use. Common reasons against earplug use included reduced hearing, discomfort, and social hindrance. Two hundred and eighty-seven (86.45%) would wear earplugs following more EACE knowledge. They preferred learning from surf community members, doctors, and surf events.

Low earplug use despite awareness of EACE preventability suggests a need for EACE education among California surfers and more accessible, user-friendly earplugs. Younger, less-skilled surfers who were more commonly unaware of EACE may represent a key intervention group. Education could be promoted through partnerships between health professionals and renowned surf organizations, as most participants indicated a willingness to use earplugs post-education.

NA Laryngoscope, 135:286-292, 2025.