The popularity of water sports in Western Australia results in a high
demand for surgery for meatal exostoses when compared to Europe or Nor
th America, and such procedures for advanced exostoses present a techn
ical challenge. We report on a decade of experience in exostosis and o
steoma surgery consisting of 127 procedures on 102 patients. Exostecto
my was an access manoeuvre for other otological procedures in 13 cases
and five procedures were for regrowth of exostoses. Minor complicatio
ns were seen after 22 per cent of operations. Major complications were
experienced after five per cent for example canal stenosis, temporoma
ndibular joint prolapse, sensorineural loss, persistent deep bony lip
and persistent tympanic membrane perforation. There were no facial pal
sies. Exostosis surgery should be reserved for failed conservative tre
atment and attention focused on adequate access, meatal skin preservat
ion and tympanic membrane protection. An approach which concentrates o
n safe anterior landmarks and wide exposure is recommended to avoid se
rious complications.