Article by Doug Hetzler, MD, FACS:

“Surfer’s ear” (medically known as “ear canal exostoses”) refers to a condition where bone growths form in the ear canal as a response to cold water exposure.  The skin of the inner ear canal is the thinnest skin in the body (paper thin) and has no insulating layer.  When cold water contacts this area, an underlying layer known as “periosteum” is stimulated to form new bone layers.  Thousands of hours of cold water stimulation in the inner ear canal leads to the creation of increasing volumes of bone.  The threshold for inciting this reaction is thought to be water colder than 20° C. (68° F.) and the colder the water the greater the stimulus for bone formation.

Some individuals have a greater tendency to form ear canal exostoses in response to cold water, so two people could have the same exposure and one could develop more pronounced bone formations than the other.  Evaporative cooling from wind blowing past a wet ear may also lead to a greater volume of exostosis formation in one ear if that ear is consistently more exposed to the wind.

As the ear canal exostoses increase in size, they may create obstruction of the ear canal and tend to trap water, ear wax and the normal layers of sloughing skin.  This can then cause decreased hearing and predispose to infection of the ear canal skin.  If these symptoms develop, an ear, nose and throat physician (otorhinolaryngologist) would typically gently clean the ear (using magnification and microsurgical tools) and prescribe antibiotic/anti-inflammatory ear drops.

To prevent the development or progression of surfer’s ear, one can use earplugs which lessen the amount of cold water entering the ear canal and also reduce the chilling effect of wind.

If the ear canal exostoses have enlarged and are causing problems, there are surgical techniques for removing the bone.  Traditionally, most ear surgeons have used a drill to remove the exostoses either via the ear canal or by making an incision behind the ear and dissecting the ear forward and then approaching the ear canal with the drill.

A newer technique is to use 1mm chisels via the ear canal to incrementally divide the exostoses along the natural cleavage planes.  This technique emphasizes preserving the thin ear canal skin which enhances the rapidity of post-operative healing.

After surgical removal of the exostoses, bone can re-grow.  Again, the use of earplugs to protect the ear canal from cold water and wind can lessen the progression of ear canal exostosis formation.

Doug Hetzler, MD, FACS

 
www.santacruzmedical.org/surfersear.html

Surfers Ear Surgical Approaches:

When the symptoms of the obstructing ear canal become intolerable, or hearing loss has occurred, it may be appropriate to consider a surgical operation called a ‘Canaloplasty’ or ‘Exostectomy’ where the surgeon digs a hole in the bone behind the ear and drills out the bony lumps, the drilling of the bone presents its own complications including a risk of hearing damage by the drill to the sensitive hearing mechanism of the ear.

The chipping technique uses a combination of a 1mm microchisel and drill to remove the exostoses, this avoids the need for an incision behind the ear; reduces the risk of noise exposure that occurs with total drilling; and helps to preserve maximum ear canal skin which encourages faster healing and recovery.

Generally either operation is a last resort as they are under general anaesthetic and can be painful. Infections during recovery, risk of fractures to the ear canal, noise damage to the ear through drilling and the close proximity of the TMJ and facial nerves to the ear canal all presents risks. It will also put you out of the water for at least two months during recovery – meaning no surfing.

Despite the surgery, bone removal does not prevent new growth, If earplugs are not worn after the ear canals have healed then the bony growths will return, this often occurs more rapidly as the protective outer harder shell of the bone is removed during surgery leaving less of the periosteum beneath the thin skin layer. Some individuals that have ignored this advice have had two or three operations to the same ear.

In short – protect your ears now and avoid the surgery, prevention is always better than cure.

More about Surfers Ear:

The medical term for surfers ear is ‘exostosis’, (plural: exostoses) which is a benign (not cancerous) slow growing bony growth or collection of bony growths under the skin layer of the ear canal that occurs when the bone is irritated by cold over many years of exposure. These narrow the ear canal and can become apparent after as little as five years of regular surfing.

It is believed that the bony growths (exostoses) associated with Surfers Ear occurs as result of cold air blowing over wet skin which lowers the temperature of the ear canal by evaporation. The skin of the inner ear canal is the thinnest skin in the body (about tissue paper thickness) and as result the ear canal is a very poor insulator.

Over time the increasing volume of the bone layers may create enough narrowing of the ear canal to start causing problems. The normal ear canal is 5-8mm in diameter (about the width of a pencil) but sufferers generally seek help once the passage has constricted to 0.5-2mm due to the noticeable hearing impairment. In extreme cases complete blockage of the ear canal can occur.

While the exostoses are not necessarily harmful in themselves, their size, number and growth pattern within the ear canal determines the likelihood of complications. Constriction of the ear canal will encourage seawater, sand or debris to get trapped deep in the ear canal and earwax or dry skin may start to plug up the narrowed section. This traps bacteria and creates a moist, warm environment causing infection which may become itchy, or create moist, inflamed or smelly skin layers in the ear canal. If left untreated these may develop into deep infections which can become very painful, more frequent and difficult to treat.

Your own Doctor or an Audiologist will be able to diagnose the presence of Surfers Ear by simple ear examination using an otoscope.  However, you may find that the professional knowledge of surfers ear varies quite widely. In most coastal areas, particularly those where surfing is prevalent, then most GP’s, Doctors and Audiologists are familiar with the presenting signs of Surfers Ear. If you are land-locked then your GP may not have seen many cases of Surfers Ear (or yours might be the first!) and some guidance to the condition may be required.

Happy Customer…

I have been surfing for around 12 years in and around North Devon, and moved to the area around 5 years ago so that I could surf more regularly. During my 3rd winter of living here I started to get problems with my ears, water wouldn't drain properly for days after surfing and I ended up with a few inner ear infections.

The doctor told me I had a developed surfers ear and should wear ear plugs or the condition would get worse. I tried Blu-tack to start with but found it would stop all sound from getting in and I would get half way through a surf and remove it and stick it to my board, or it would fall out or it wouldn't seal very well. I then moved to disposable silicone plugs but found they still wouldn't seal properly and had a tendency to fall out. By this time I had a recurring ear infection which was costing a fortune in antibiotics and the doctor told me my surfers ear was getting worse (50-60% blocked in my right ear and 40% in my left).

After talking to people who had had to get their ears drilled I decided that wasn’t for me and saw Rob who was doing a Surfplug and surfers ear clinic at my local surf shop.

I had some plugs fitted which only took about quarter of an hour and they were shaped and delivered to me within 48hours. Since then I have worn them almost every surf, I have only had one ear infection in the two years I’ve had the surfplugs (and I think I got that when I forgot them on a trip away down the coast!).

It took me about 2 weeks to get used to wearing them and hearing less external noise but they seem to let in more sound than Blu-tack. I had been really worried about losing my plugs because they cost quite a lot of money but I even had my hood ripped from my head at Croyde this winter and my plugs stayed in.  They even seem to make you feel a bit warmer in winter surfs (I don’t wear a hood very often now!).

I had my ears checked about a week ago and my Surfers ear is still the same level as when I started wearing the plugs. I would recommend getting them before you have the problems and pain of recurring infections and partial deafness. I figure they have now cost me pence per surf session, I’ve saved money by not paying for antibiotic prescription and I haven’t thrown away packets of Blu-tack or disposable plugs helping the environment. Overall I can’t thank you enough Rob for a great product, and great service.

Ian Allison / Ramon