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Mays S, Stark S, Zakrzewski S, Vekony A. Which types of bony changes in the maxillary sinus indicate chronic sinusitis? INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:16-23. [PMID: 38865933 DOI: 10.1016/j.ijpp.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To determine which types of bone lesion (spicules, lobules, porous bone) in the maxillary sinus indicate sinusitis METHODS: Subadjacent dental disease is a cause of maxillary sinusitis; if a lesion type indicates sinusitis it should be more common above diseased posterior maxillary teeth than a lesion type that is not indicative of sinusitis. The study sample is a British Mediaeval human skeletal collection. RESULTS Porous bone lesions (chiefly new bone deposits) in maxillary sinuses are associated with subadjacent dental disease; spicules/lobules of bone in the sinus are not. CONCLUSIONS The results support the idea that porous lesions indicate sinusitis but the spicules/lobules may not. Spicules, lobules and porous lesions within the maxillary sinus should be analysed separately in biocultural studies; it would be prudent to regard only the porous lesions as indicative of sinusitis. SIGNIFICANCE Maxillary sinusitis is commonly used as a health indicator in palaeopathology, and spicular deposits are generally the most common type of alterations. By assuming that they are indicative of sinusitis we may have been greatly overestimating the prevalence of bony sinusitis in the past. LIMITATIONS These conclusions are provisional. Further work on larger, more diverse samples, together with more detailed anatomical studies on lesion location and structure is ongoing.
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Affiliation(s)
- S Mays
- Investigative Science, Historic England, UK; Department of Archaeology, University of Southampton, UK; School of History, Classics and Archaeology, University of Edinburgh, UK.
| | - S Stark
- Investigative Science, Historic England, UK; Department of Archaeology, University of Southampton, UK
| | - S Zakrzewski
- Department of Archaeology, University of Southampton, UK
| | - A Vekony
- Department of Archaeology, University of Southampton, UK
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Leclère JC, Cerceau L, Mornet E, Marianowski R. External ear canal exostectomy: influence of surgeon's experience on 3-years recurrence and occurrence of complications. EAR, NOSE & THROAT JOURNAL 2024; 103:351-356. [PMID: 34791926 DOI: 10.1177/01455613211056555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND External ear canal exostoses are usually bilateral and broad-based, secondary to external ear canal chronic cold exposure, especially water. OBJECTIVES The objectives were to analyze the influence of the surgeon's experience on the 3-year recurrence and on the complication. We also studied the influence of prolonged exposure to cold water on the incidence of recurrence. MATERIAL AND METHODS This monocentric retrospective study included 98 ears operated for canalplasty between 2009 and 2016 by nine different operators including one senior, a junior, and seven beginner surgeons. Senior, Junior, and Beginner groups were compared. RESULTS 3-year recurrence rate was higher in the Beginner and Junior groups than in the Senior group (69% and 38% vs 18%, P = .001). Although there was a difference between the Beginner (69%) and Junior (38%) groups, it was not significant (P = .407). Among the recurrences, 48% had continued exposure to cold water while only 7% of the ears without recidivism were still exposed (P < .001, OR = 1.25 [4.4; 36.1]). The complication rates were similar between groups, concerning pain (8% vs 30% vs 12%), per procedure perforation (17% vs 10% vs 16%), scarring disorders (25% vs 20% vs 13%), and osteitis (8% vs 0% vs 1%). Hearing was unaffected. CONCLUSIONS This is the first study evaluating the risk of recurrence of external ear canal exostoses after canalplasty based on the surgeon's experience. This risk of recurrence seems to decrease with the surgeon's experience. There was no difference in complication rates.
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Affiliation(s)
| | - Laura Cerceau
- Department of Head and Neck Surgery, Brest University Hospital, Brest, France
| | - Emmanuel Mornet
- Department of Head and Neck Surgery, Brest University Hospital, Brest, France
| | - Rémi Marianowski
- Department of Head and Neck Surgery, Brest University Hospital, Brest, France
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Vallée A. External auditory exostosis among surfers: a comprehensive and systematic review. Eur Arch Otorhinolaryngol 2024; 281:573-578. [PMID: 37777626 DOI: 10.1007/s00405-023-08258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
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.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France.
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Wegener F, Wegner M, Weiss NM. What do windsurfers and kitesurfers in Germany know about surfer's ear and how is it influenced by protective measures? J Laryngol Otol 2024; 138:52-59. [PMID: 37016896 PMCID: PMC10772022 DOI: 10.1017/s0022215123000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023]
Abstract
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.
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Affiliation(s)
- F Wegener
- Institute of Sport Science, Christian-Albrechts University, Kiel, Germany
| | - M Wegner
- Institute of Sport Science, Christian-Albrechts University, Kiel, Germany
| | - N M Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St Elisabeth Hospital, Bochum, Germany
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- International Graduate School of Neuroscience, Ruhr University Bochum, Bochum, Germany
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An awareness and prevalence study of Irish cold-water athletes and external auditory canal exostoses. The Journal of Laryngology & Otology 2022; 136:659-667. [DOI: 10.1017/s0022215121004369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThis study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes.MethodAn online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures.ResultsOf the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis.ConclusionThe majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.
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Wille AE, Pazdernik VK, Sassounian N, Glaser K. Prevention of external auditory canal exostosis in the Colorado whitewater community. J Osteopath Med 2022; 122:431-437. [DOI: 10.1515/jom-2021-0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
Abstract
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.
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Affiliation(s)
- Annalise E. Wille
- A.T. Still University School of Osteopathic Medicine , Mesa , AZ , USA
| | | | - Nicole Sassounian
- A.T. Still University School of Osteopathic Medicine , Mesa , AZ , USA
| | - Kelli Glaser
- Rocky Vista University School of Osteopathic Medicine , Parker , CO , USA
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Manninen IK, Jutila T, Hirvonen T, Mäkinen LK, Blomgren K, Hyytiä T, Klockars T. Dizzy triathlete-evidence supporting vestibular etiology. Scand J Med Sci Sports 2021; 31:2267-2271. [PMID: 34449937 DOI: 10.1111/sms.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Dizziness during or after the swimming leg is a common complaint among triathletes. We hypothesized that the dizziness is caused by asymmetrical cooling of the vestibular organ. This caloric response is characterized by involuntary eye movements called nystagmus. Altogether, 125 triathletes completed an electronic questionnaire. Fifteen triathletes who had frequently experienced dizziness during the swimming leg agreed to take part in a cold water swimming test. The test comprised two cold water swimming legs, first without earplugs and then with earplugs to prevent a potential caloric response. Eye movements and possible nystagmus were recorded immediately after the swimming legs. A majority (87%, 109/125) of athletes had experienced dizziness during triathlon races or training. Of these, almost all (97%, 106/109) experienced it during or after swimming. Dizziness affected the triathlon performance in half of the athletes with dizziness (50%, 51/102). Fifteen athletes participated in a cold water swimming test. During the first leg (without earplugs), 11/15 athletes (73%) experienced dizziness. Of these, six had nystagmus (55%), four had uncertain nystagmus (36%), and one did not have nystagmus (9%). Only one of these athletes experienced dizziness during the second leg with earplugs. The prevalence of dizziness among triathletes is notable. A large part of the dizziness is likely to be caused by caloric reaction of the vestibular organ. We recommend earplug usage for triathletes suffering from dizziness during the swimming leg.
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Affiliation(s)
- Iida-Kaisa Manninen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Topi Jutila
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Hirvonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura K Mäkinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karin Blomgren
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomas Hyytiä
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Tuomas Klockars
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Wegener F, Wegner M, Weiss NM. External auditory exostoses in wind-dependent water sports participants: German wind- and kitesurfers. Eur Arch Otorhinolaryngol 2021; 279:2353-2361. [PMID: 34146149 PMCID: PMC8986730 DOI: 10.1007/s00405-021-06939-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022]
Abstract
Purpose Cold water and wind are known to cause exostoses of the external auditory canal. Different prevalences in different sports have been described in the literature. The aim of this study was to investigate the prevalence of external auditory exostosis (EAE) and EAE severity in coastal German wind- and kitesurfers who are exposed to cold water and strong winds. Furthermore, influencing factors such as the total exposure time and frequency of activity as well as the correlations between symptoms and the severity of EAE were investigated. Methods In this retrospective cross-sectional study, German non-professional wind- and kitesurfers along the North and Baltic Sea coasts were recruited between September 2020 and November 2020. Each participant was interviewed about exposure time and otological symptoms and underwent bilateral video otoscopic examination to determine EAE severity. Results A total of 241 ears from 130 subjects were analysed. The prevalence of EAE was 75.1%. In 19.9% of the participants, severe EAE was found. Exposure time and the frequency of activity had significant effects on the severity of EAE. Compared to surfers, EAE growth seems to progress faster in wind- and kitesurfers. The number of symptoms requiring medical treatment increased when two-thirds of the external auditory canal was obstructed. Conclusion The prevalence of EAE in wind- and kitesurfers is high. Total exposure time and the frequency of activity influence EAE growth. EAE growth occurs faster in wind- and kitesurfers than in surfers. The additional influence of wind and the evaporative cooling of the EAC are thought to be responsible. The results of this study should increase awareness of the dynamics of EAE among ENT specialists and improve patient counselling.
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Affiliation(s)
- Florian Wegener
- Institute of Sport Science, Christian-Albrechts-University Kiel, Olshausenstraße 74, 24098, Kiel, Germany.
| | - Manfred Wegner
- Institute of Sport Science, Christian-Albrechts-University Kiel, Olshausenstraße 74, 24098, Kiel, Germany
| | - Nora M Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery "Otto Körner", Rostock University Medical Center, Doberaner Strasse 137-139, 18057, Rostock, Germany
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Simas V, Hing W, Rathbone E, Pope R, Climstein M. Auditory exostosis in Australian warm water surfers: a cross-sectional study. BMC Sports Sci Med Rehabil 2021; 13:52. [PMID: 33990216 PMCID: PMC8122542 DOI: 10.1186/s13102-021-00281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Surfing is a popular sport in Australia, accounting for nearly 10% of the population. External auditory exostosis (EAE), also referred to as surfer's ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19 °C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80%. However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19 °C. With mean water temperature ranging from 19 °C to 28 °C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers. METHODS Eligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy. RESULTS A total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment. CONCLUSION To the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 °C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.
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Affiliation(s)
- Vini Simas
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia.
| | - Wayne Hing
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rodney Pope
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Mike Climstein
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing, Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Impact of ear protection on occurrence of exostosis in surfers: an observational prospective study of 242 ears. Eur Arch Otorhinolaryngol 2021; 278:4775-4781. [PMID: 33555441 DOI: 10.1007/s00405-021-06609-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 01/05/2021] [Indexed: 01/17/2023]
Abstract
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.
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Hanchard S, Duncan A, Furness J, Simas V, Climstein M, Kemp-Smith K. Chronic and Gradual-Onset Injuries and Conditions in the Sport of Surfing: A Systematic Review. Sports (Basel) 2021; 9:23. [PMID: 33572826 PMCID: PMC7911480 DOI: 10.3390/sports9020023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
The majority of the previous literature investigating injuries in surfing have focused on acute or traumatic injuries. This systematic review appears to be the first to investigate the literature reporting on chronic and gradual-onset injuries and conditions in surfing populations. A search strategy was implemented on five databases in June 2020 to locate peer-reviewed epidemiological studies on musculoskeletal injuries or non-musculoskeletal conditions in surfing. A modified AXIS Critical Appraisal Tool was used to appraise all included texts. Extracted data included key information relevant to the epidemiology of the injuries and conditions. Twenty journal articles were included with the majority rated as good quality and a substantial agreement between raters (k = 0.724). Spine/back (29.3%), shoulder (22.9%), and head/face/neck (17.5%) were the most frequently reported locations of musculoskeletal injury, whilst the most common mechanism of injury was paddling (37.1%). Exostosis was the most frequently described injury or condition in surfing populations, with the most common grade of severity reported as mild obstruction. The key findings of injury type, location, severity, and mechanism can be used to develop relevant injury management and prevention programs for the surfing population, with an emphasis on chronic or gradual-onset spine/back and shoulder injuries, paddling technique, and education on the development and management of exostosis.
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Affiliation(s)
- Samuel Hanchard
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Ashley Duncan
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - James Furness
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Vini Simas
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
| | - Mike Climstein
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
- Clinical Exercise Physiology, School of Health and Human Sciences, Southern Cross University, Bilinga, QLD 4225, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing, Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2006, Australia
| | - Kevin Kemp-Smith
- Water Based Research Unit, Faculty of Health Sciences, Bond University, Gold Coast, QLD 4207, Australia; (A.D.); (J.F.); (V.S.); (M.C.); (K.K.-S.)
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DOĞAN E, KULE M, GÜNEY B, ALTUN İ, TOGAN T. The symptomatic bilaterally occlusive surfer’s air (exostosis of the external auditory canal). JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.710022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Simas V, Hing W, Pope R, Climstein M. Australian surfers' awareness of 'surfer's ear'. BMJ Open Sport Exerc Med 2020; 6:e000641. [PMID: 32153980 PMCID: PMC7047473 DOI: 10.1136/bmjsem-2019-000641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess awareness of external auditory exostosis (EAE) among Australian surfers. Methods This is a cross-sectional observational study, assessing professional and recreational Australian surfers. Currently, active surfers over 18 years of age, surfing year-round, were eligible to participate. After initial screening, individuals were asked to complete a questionnaire. All included volunteers underwent bilateral otoscopic examination, to assess the presence and severity of EAE. Results A total of 113 surfers were included in the study and were divided into two groups, based on surfing status: 93 recreational surfers and 20 professional surfers. Recreational surfers were significantly older (p<0.005), more experienced (greater years surfing; p<0.005), with lower prevalence of otological symptoms (p<0.05). The most common symptoms were water trapping, impacted wax and hearing loss. Prevalence of EAE was high for both groups (95% in the professional surfers and 82.8% in the recreational surfers); however, recreational surfers had mild grade EAE (grade 1) as the most common presentation, as opposed to professionals who had severe grade EAE (grade 3) as the most common presentation (p<0.05 between groups). Awareness of the term ‘surfer’s ear’ was high for both groups, as was knowledge of prevention options. However, fewer considered the condition to be preventable, and an even lower number reported regular use of prevention methods. Conclusion Australian surfers had a high level of awareness of EAE; however, few reported using prevention methods, despite having a high prevalence of the condition. Health practitioners should screen susceptible individuals in order to recommend appropriate preventive measures.
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Affiliation(s)
- Vini Simas
- Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Rodney Pope
- School of Community Health, Charles Sturt University, Albury, New South Wales, Australia
| | - Mike Climstein
- Water Based Research Unit, Bond Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.,School of Health and Human Sciences, Southern Cross University - Gold Coast Campus, Gold Coast, Queensland, Australia
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The Prevalence and Severity of External Auditory Exostosis in Young to Quadragenarian-Aged Warm-Water Surfers: A Preliminary Study. Sports (Basel) 2020; 8:sports8020017. [PMID: 32033062 PMCID: PMC7077213 DOI: 10.3390/sports8020017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 01/26/2020] [Indexed: 01/22/2023] Open
Abstract
External auditory exostosis (EAE) has previously only been shown to occur in cold water surfers. We assessed young surfers living and surfing in Queensland, Australia, for EAE in water temp ranges from 20.6 °C (69.1 °F, Winter) to 28.2 °C (82.8 °F, Summer). All participants underwent a bilateral otoscopic examination to assess the presence and severity of EAE. A total of 23 surfers participated with a mean age of 35.4 years (8.3 years) and a mean surfing experience of 20.0 years (9.9 years). Nearly two-thirds of participants (n = 14, 60.9%) had regular otological symptoms, most commonly water trapping (n = 13, 56.5%), pain (n = 8, 34.8%), and hearing loss (n = 6, 26.1%). Only 8.7% (n = 2) of all surfers reported regular use of protective equipment (e.g., earplugs) on a regular basis. The overall prevalence of exostosis was 69.6% (n = 16), and the majority (n = 12, 80.0%) demonstrated bilateral lesions of a mild grade (<33% obstruction of the external auditory canal). This is the first study assessing EAE in young surfers exposed to only warm waters (above 20.6 °C). The prevalence of EAE in this study highlights that EAE is not restricted to cold water conditions, as previously believed. Warm water surfing enthusiasts should be screened on a regular basis by their general medical practitioner and utilize prevention strategies such as earplugs to minimize exposure to EAE development.
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Reduction of cicatricial stenosis after canalplasty for auditory exostoses. The Journal of Laryngology & Otology 2019; 133:814-817. [PMID: 31434604 DOI: 10.1017/s0022215119001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Canalplasty for auditory exostoses is reserved for symptomatic patients. This study reviewed the outcomes of our technique regarding cicatricial stenosis. METHOD A chart review was conducted on patients undergoing canalplasty for auditory exostoses between 2002 and 2017. The surgical technique is described. RESULTS The study comprised 43 adults (50 operated ears). Exostoses were bilateral in 40 cases (94 per cent) and occlusive in 33 (66 per cent). After drilling, the external auditory meatus was covered with a graft in 34 cases (68 per cent) and a silicone sheet was used in 32 (64 per cent). Cicatricial stenosis appeared in eight cases (16 per cent). Skin grafts were not used in six of these eight cases (p < 0.04), and silicone sheets were used only in one of these eight (p < 0.01). CONCLUSION Canalplasty is challenging because of its potential complications. Our data showed that the use of skin grafts and silicone sheets to cover the bared external auditory meatus was associated with a lower rate of cicatricial stenosis.
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Simas V, Remnant D, Furness J, Bacon CJ, Moran RW, Hing WA, Climstein M. Lifetime prevalence of exostoses in New Zealand surfers. J Prim Health Care 2019; 11:47-53. [PMID: 31039989 DOI: 10.1071/hc18097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/07/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION External auditory exostosis (EAE) is a benign, irreversible bony outgrowth that arises from the temporal bone. EAE projects into the external ear canal, potentially causing recurrent otitis externa and conductive hearing loss. AIM To determine lifetime prevalence of EAE in New Zealand (NZ) surfers. METHODS This study used an online national survey. RESULTS Respondents were 1376 NZ surfers (recreational = 868, competitive = 508). Mean surfing experience was 16.2 years. Most self-classified as advanced surfers (36.5%), followed by intermediate (30.2%), expert (20.1%) and beginner (13.2%). Surfers reported an average of 214.2 h surfing (28.6% during winter) for the previous year. Overall lifetime prevalence of EAE was 28.9% (32.1% male, 14.6% female; P < 0.001), with the highest proportion of EAE was observed bilaterally (21.3%). Competitive surfers reported a significantly (P < 0.001) higher lifetime prevalence of EAE than recreational surfers (45.3% vs. 19.2%). A significantly higher (P < 0.001) lifetime prevalence of EAE was identified as skill level increased (7.1% in beginners to 55.6% in experts) and a two-fold increase (P < 0.001) of EAE in the highest (vs. lowest) quartile of surfing exposure. Neither winter surfing exposure nor which Island surfed were associated with EAE prevalence. DISCUSSION Although not as prevalent as in previous NZ research using otologic examinations, this study indicated that almost one-third of NZ surfers reported having had a diagnosis of EAE. Regular general practitioner otologic assessment and advice on appropriate prevention strategies for patients who surf may help prevent large lesions, recurrent ear infections and progressive hearing loss.
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Affiliation(s)
- Vini Simas
- Water Based Research Unit, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; and Corresponding author.
| | - Debbie Remnant
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - James Furness
- Water Based Research Unit, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Catherine J Bacon
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand; and Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Robert W Moran
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Wayne A Hing
- Water Based Research Unit, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Mike Climstein
- Water Based Research Unit, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; and School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia; and Exercise Health & Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Castano D, Comeau-Gauthier M, Ramirez-GarciaLuna JL, Drager J, Harvey E, Merle G. Noninvasive Localized Cold Therapy: A New Mode of Bone Repair Enhancement. Tissue Eng Part A 2019; 25:554-562. [DOI: 10.1089/ten.tea.2018.0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Daniel Castano
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | | | - Jose Luis Ramirez-GarciaLuna
- Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Canada
- Bone Engineering Labs, Research Institute-McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Justin Drager
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Edward Harvey
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Geraldine Merle
- Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
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Smith‐Guzmán NE, Cooke RG. Cold‐water diving in the tropics? External auditory exostoses among the pre‐Columbian inhabitants of Panama. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 168:448-458. [DOI: 10.1002/ajpa.23757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Richard G. Cooke
- Smithsonian Tropical Research Institute Ancón Panamá Republic of Panamá
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Paddock M, Lau K, Raghavan A, Dritsoula A. Surfer's exostosis in a child who does not surf. Radiol Case Rep 2018; 13:531-533. [PMID: 29849851 PMCID: PMC5966629 DOI: 10.1016/j.radcr.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/03/2018] [Indexed: 11/24/2022] Open
Abstract
Surfer's exostoses are more commonly seen in adults who frequently participate in aquatic activities with repeated exposed to cold water and wind. However, this entity has not been previously reported in the pediatric population. Most patients can be managed conservatively, particularly considering that surgical removal of external auditory canal exostosis can be challenging.
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Affiliation(s)
- Michael Paddock
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - Kimberley Lau
- Department of Otolaryngology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - Ashok Raghavan
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
| | - Aikaterini Dritsoula
- Department of Otolaryngology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
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Barbon DA, Hegde R, Li S, Abdelbaki A, Bajaj D. Bilateral External Auditory Exostoses Causing Conductive Hearing Loss: A Case Report and Literature Review of the Surfer's Ear. Cureus 2017; 9:e1810. [PMID: 29308338 PMCID: PMC5749938 DOI: 10.7759/cureus.1810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In patients with repeated exposure to cold water, such as cold water surfers and kayakers, the reactive exostoses can occur in the external auditory canal. The external auditory canal exostoses are multiple, benign bony growths. They can cause external auditory canal stenosis, leading to repeated otitis externa and potentially conductive hearing loss. It is vital to consider this entity in susceptible patients who report hearing loss, as timely intervention such as proper ear protection equipment can lower the risk of developing severe external auditory canal exostoses. We present a case of a 42-year-old male, cold water surfer with conductive hearing loss and bilateral external auditory canal (EAC) stenosis demonstrated on the computed tomography.
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Affiliation(s)
- Dennis A Barbon
- Frank H. Netter, Md School of Medicine, Quinnipiac University
| | - Rahul Hegde
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital
| | - Shuo Li
- Department of Radiology, Yale New Haven Health at Bridgeport Hospital
| | - Ahmed Abdelbaki
- Diagnostic Radiology, Yale New Haven Health at Bridgeport Hospital
| | - Divyansh Bajaj
- Department of Internal Medicine, St. Vincent Medical Center, Bridgeport, Ct
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Abstract
OBJECTIVE To describe a novel approach for excision of exostoses and evaluate the outcomes of transcanal excision of exostoses using ultrasonic serrated knife-assistance versus microosteotomes only. STUDY DESIGN Retrospective analysis. SETTING Academic Tertiary Care Center. PATIENTS/INTERVENTIONS Patients receiving a transcanal excision of exostoses between 2007 and 2016. MAIN OUTCOME MEASURES The outcomes and postoperative complications of 138 patients who received transcanal microosteotome only technique were compared to 10 patients who received transcanal excision of exostoses using ultrasonic serrated knife-assistance (Stryker Corporation, Kalamazoo, MI). RESULTS A total of 175 ears in 128 patients underwent a transcanal microosteotome only technique. Of these, 11 (6.3%) developed an intraoperative tympanic membrane perforation. One developed anterior canal mobilization requiring prolonged (3 wk) packing. One hundred thirty-five ears (77%) were well healed by the 3-week postoperative visit. All but one ear was well healed by the 6-week visit. In comparison, 11 ears in 10 patients were treated for exostoses using a transcanal approach with the use of ultrasonic serrated knife and microosteotomes. One ear canal (the first in the series) was not well healed by the 3-week postoperative visit due to suspected thermal injury. All patients had well-healed ear canals by 6 weeks, and there were no complications. CONCLUSION This is the first series to report the use of an ultrasonic serrated knife in the transcanal excision of exostoses. When compared with a transcanal microosteotome only excision of exostoses, the addition of the Sonopet seems to result in a similarly low complication rate. Sonopet can allow for more controlled transcanal excision of broad-based exostoses in patients with severe obstruction.
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Castro M, Goycoolea M, Silva-Pinto V. External ear canal exostosis and otitis media in temporal bones of prehistoric and historic chilean populations. A paleopathological and paleoepidemiological study. Acta Otolaryngol 2017; 137:365-369. [PMID: 27834109 DOI: 10.1080/00016489.2016.1249949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSIONS External ear canal exostosis is more prevalent in northern coastal groups than in the highlands, suggesting that ocean activities facilitate the appearance of exostosis. However, southern coastal groups exposed to colder ocean water have a lesser incidence of exostosis, possibly due to less duration of exposure. There was a high incidence of otitis media in all groups of native population in Chile. One coastal group had a higher incidence, presumably due to racial factors. BACKGROUND This is a paleopathological and paleoepidemiological study in temporal bones which assesses external ear canal exostosis and otitis media in prehistoric and historic native populations in Chile. MATERIALS AND METHODS A total of 460 temporal bones were evaluated for exostosis (ex) and 542 temporal bones were evaluated for otitis media (om). The study involved four groups: (1) Prehistoric Coastal (400-1000 AD) populations in Northern Chile (Pisagua-Tiwanaku) (22 temporal bones ex; 28 om); (2) Prehistoric Highland (400-1000 AD) populations in Northern Chile (292 temporal bones ex; 334 om); (3) Pisagua-Regional Developments (coastal) in Northern Chile (1000-1450 AD) (66 temporal bones ex; 82 om); and (4) Historic (1500-1800 AD) coastal populations in Southern Chile (80 temporal bones ex: 18 Chonos, 62 Fuegians. 98 om: 22 Chonos, 76 Fuegians). Skulls were evaluated visually and with an operating microscope. In addition, the otitis media group was evaluated with Temporal bone radiology - -lateral XRays-Schuller view - to assess pneumatization as evidence of previous middle ear disease. RESULTS Prehistoric northern coastal groups had an incidence of exostosis of 15.91%, the northern highlands group 1.37%, and the southern coastal group 1.25%. There were changes suggestive of otitis media in: Pisagua/Tiwanaku 53.57%; Pisagua/Regional Developments 70.73%; Northern Highlands population 47.90%; Chonos 63.64%; and Fuegian tribes 64.47%.
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Affiliation(s)
- Mario Castro
- Department of Morphology, School of Medicine, Clínica-Alemana-Universidad del Desarrollo, Santiago, Chile
- Department of Museums, Dibam, Santiago, Chile
| | - Marcos Goycoolea
- Department of Otolaryngology, Clínica las Condes, Santiago, Chile
| | - Verónica Silva-Pinto
- Department of Anthropology, National Museum of National History, Santiago, Chile
- Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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Hirose Y, Shikino K, Ikusaka M. Surfer's ear and external auditory canal exostoses. QJM 2016; 109:759. [PMID: 27516233 DOI: 10.1093/qjmed/hcw148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 07/28/2016] [Indexed: 11/12/2022] Open
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Awareness and attitudes towards external auditory canal exostosis and its preventability in surfers in the UK: cross-sectional study. The Journal of Laryngology & Otology 2016; 130:628-34. [DOI: 10.1017/s0022215116008082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives: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.
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