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This was a cold water swimmer who presented

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with painful bilateral ear pain.

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And on the axial CT scan images on this case,

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we come into the external auditory canal and we see

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that there are blocks of bone that appear to be

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encroaching on the external auditory canal,

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both anteriorly as well as posteriorly

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on the right side.

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In addition,

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you note that there's a little bit of narrowing of

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the aperture of the external auditory

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canal along the medial aspect of it.

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The middle ear cavity looks pretty good.

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We're not seeing the tympanic membrane quite so

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good on the right side.

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On the left side,

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we actually see the tympanic membrane is somewhat

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thickened and it's on the external

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auditory canal portion of it.

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This is this little area here where the

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malleus is inserting as the umbo.

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So that's on the middle ear side and no

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opacification of the middle ear cavity.

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On the extraordinary canal on the left side,

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you again see some of this thickening which appears

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to affect the anterior wall and inferior wall of the

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extra auditory canal more so than the superior wall.

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Note that even though there is

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that thickening of the wall,

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we really don't see any soft tissue thickening

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of the external auditory canal on either side.

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On the coronal scan,

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what is apparent is that the bony canal narrowing is

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predominantly due to the bony overgrowth

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bilaterally of the inferior,

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more so than the superior wall of the external

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auditory canal. Overlying it,

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no soft tissue. Medial to it,

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along the tympanic membrane on the left side,

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you see that there is an element of inflammation

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that's up against the tympanic membrane on the left.

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So this is a patient, by virtue of having bilateral

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involvement associated with external auditory canal

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stenosis from that bony overgrowth is a

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characteristic feature of cold

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water swimmers and exostosis.

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This patient's canal narrowing of the medial aspect

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of the external auditory canal

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was apparent also at the time of the

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surgery for removal of those exostoses.