{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:59:33Z","timestamp":1781002773958,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2010,1,11]],"date-time":"2010-01-11T00:00:00Z","timestamp":1263168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2010,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives\/Hypothesis.<\/jats:title><jats:p>Exostoses of the external auditory canal are benign bony tumors associated with frequent cold\u2010water exposure. Obstruction may lead to conductive hearing loss and recurrent otitis externa, requiring surgical correction when symptoms become intolerable. This study aimed to characterize the prevalence of exostoses in white\u2010water kayakers and identify associated risk factors and protective measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design.<\/jats:title><jats:p>Cross\u2010sectional.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Six hundred eleven white\u2010water kayakers from across the United States were included in the study. Percent occlusion was graded as minimal (&lt;25%), moderate (25%\u201375%) or severe (&gt;75%). Subjects completed a survey of risk factors and protective measures. Kruskal\u2010Wallis and \u03c7<jats:sup>2<\/jats:sup> tests were performed to determine significant associations with percent occlusion. A multivariate proportional odds regression model was fit to adjust for confounding between the variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The prevalence of exostoses in kayakers was 79% (482\/611); 13% (78\/611) had \u226575% occlusion. Percent occlusion was associated with total years kayaked (<jats:italic>P<\/jats:italic> &lt; .001), frequency \u22651 day\/week (<jats:italic>P<\/jats:italic> &lt; .001), male gender (<jats:italic>P<\/jats:italic> &lt; .001), and increasing age (<jats:italic>P<\/jats:italic> = .005), although frequency, gender, and age were confounded by total years. Styles that involve repeated submersion were also associated with greater occlusion (freestyle, <jats:italic>P<\/jats:italic> = .036; squirt, <jats:italic>P<\/jats:italic> = .016). Subjects who used earplugs for a greater proportion of their kayaking career were less likely to have exostoses (<jats:italic>P<\/jats:italic> &lt; .001). When adjusted for confounding, only total years (<jats:italic>P<\/jats:italic> = .0003) and age (<jats:italic>P<\/jats:italic> = .0027) remained significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Kayakers are the first inland population to experience exostoses at the rates seen in coastal populations (e.g., surfers). When used long\u2010term, earplugs may be protective. Laryngoscope, 2010<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.20781","type":"journal-article","created":{"date-parts":[[2010,1,11]],"date-time":"2010-01-11T22:36:42Z","timestamp":1263249402000},"page":"582-590","source":"Crossref","is-referenced-by-count":28,"title":["Exostoses of the external auditory canal in white\u2010water kayakers"],"prefix":"10.1002","volume":"120","author":[{"given":"Ryan D.","family":"Moore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodore A.","family":"Schuman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa A.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott E.","family":"Mann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario A.","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Labadie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2010,1,11]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/00034894790880S601"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.125.9.969"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31802cbb12"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215100126027"},{"key":"e_1_2_7_6_2","first-page":"187","article-title":"The relationship of osteomata of the external auditory meatus to swimming","volume":"31","author":"Harrison DF","year":"1962","journal-title":"Ann R Coll Surg Engl"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8644(199707)103:3<417::AID-AJPA12>3.0.CO;2-3"},{"key":"e_1_2_7_8_2","volume-title":"A Manual of Diseases of the Ear","author":"Field GP","year":"1893"},{"key":"e_1_2_7_9_2","volume-title":"Manual of Diseases of the Ear: Including Those of the Nose and Throat in Relation to the Ear for the Use of Students and Practitioners of Medicine","author":"Barr T","year":"1901"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.20544"},{"key":"e_1_2_7_11_2","first-page":"424","article-title":"The aetiology of swimmers' exostoses of the external auditory canals and of associated changes in hearing","volume":"42","author":"Adams WS","year":"1949","journal-title":"Proc R Soc Med"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1159\/000275702"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215108001850"},{"key":"e_1_2_7_14_2","first-page":"16","article-title":"Cold weather gear","volume":"20","author":"Sweeney B","year":"1985","journal-title":"Am Whitewater J"},{"key":"e_1_2_7_15_2","unstructured":"Outdoor Industry Association. 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