The popularity of water sports in Western Australia results in a high demand for surgery for meatal exostoses when compared to Europe or North America, and such procedures for advanced exostoses present a technical challenge. We report on a decade of experience in exostosis and osteoma surgery consisting of 127 procedures on 102 patients. Exostectomy was an access manoeuvre for other otological procedures in 13 cases and five procedures were for regrowth of exostoses. Minor complications were seen after 22 per cent of operations. Major complications were experienced after five per cent for example canal stenosis, temporomandibular joint prolapse, sensorineural loss, persistent deep bony lip and persistent tympanic membrane perforation. There were no facial palsies. Exostosis surgery should be reserved for failed conservative treatment and attention focused on adequate access, meatal skin preservation and tympanic membrane protection. An approach which concentrates on safe anterior landmarks and wide exposure is recommended to avoid serious complications.