30 August, 2016 30 August, 2016

Surfer’s Ear: Breakthrough Treatment

Not only are sharks, leaky wetsuits and hypothermia a threat to the cold-blooded surfers of the Cape, but so is the common Surfer’s Ear – a painful closing of the ear canal that can cause infection and even deafness. Operating on Surfer’s Ear a.k.a exostoses is among the most challenging and difficult surgeries that an ENT surgeon can perform, and according to Dr. Martin Young, an ENT surgeon and lifelong scuba-diver from Knysna, many modern surgeons are getting it all wrong.

We catch up with Dr. Young to get the low-down on Surfer’s Ear – prevention, cure and how reverting back to traditional methods of surgery, as he does, could save you time, money and your precious saltwater sessions. If you’re a cold-water surfer or an exostoses sufferer – huddle up and listen in close…

FEATURED-surfers-ear-greg-ewing

Surfer’s Ear effects many surfers who frequently spend time in icy waters and chilly wind… at places like Elandsbay.

ZIGZAG: Hit us with the inconvenient truth: What is Surfer’s Ear?

DR. MARTIN YOUNG: Surfer’s Ear or exostoses is the progressive growth of one or more bony surfaces or walls of the middle part of the ear canal resulting in partial or complete closure of the ear canal and all the consequences thereof – trapped water, deafness and repeated infections.

Why does the name ‘Surfer’s Ear’ pick on surfers specifically? Why is it not called seal’s ear, swimmer’s ear or diver’s ear?

Good question. My view is that it is related to the repeated in-and-out-the-water changes in ear canal temperature and the wind chill factor. Surfers do not spend as much time in the water as scuba divers, but the latter seem to suffer far fewer exostoses, because the temperature in their ear canals is not constantly changing. Make sense?

DIAGRAM-EXOSTOSIS-Dr-Louis-Hofmeyr

(Left) Ear canal effected by exostosis / Surfer’s Ear. (Right) Regular healthy ear canal. Images provided by Dr. Louis Hofmeyr.

In, out, cold water, wind. Got it. On that note, could you elaborate on the causes? Are you sure this isn’t just bad surf karma for surfers who don’t listen good?

Yep, cold water, and windy surflines – the wind chill factor is a big deal. Some surfers have large exostoses on one side, and small or none on the other, presumably due to the dominant wind direction on their favourite breaks. Some people are more inclined to develop exostoses though and can often blame their parents (rather than karma).

What are the symptoms of Surfer’s Ear? What signs should we be listening out for? (aside from shoddy puns).

Water that does not drain after a swim or a surf. An increased tendency to get ear infection and easy blocking of the ears. A good GP can tell you if you have Surfer’s Ear.

Namibua5733Ewing

Surfers are more susceptible to Surfer’s Ear due to cold-water, windy surflines and being in and out the water.

What’s the worse case you’ve ever seen? Are there a significant amount of surfers who can’t surf because of it? Poseidon forbid.

I’ve seen and treated many patients with complete closure of their ear canals and a 60% hearing loss as a result. It’s not that it stops people surfing, but the long term consequences of hearing loss are significant. The ear canal bone covers two very important structures – the jaw joint in front and the facial nerve at the lower back. It is very easy to ‘get lost’ when the exostoses completely cover the eardrum, and one can end up drilling or chiselling into these two structures. The jaw joint will heal over time, but the facial nerve if cut may leave the patient with a completely paralysed face – not good at all! On the far side of the exostoses is the eardrum, and in some cases they are in direct contact with it, and the ear drum may get injured – not usually too big an issue.

We'd hate to see the likes of Matt Bromley being stumped by a closing canal...

We’d hate to see the likes of cold-water surfer, Matt Bromley, being stumped by a closing canal…

Ears are an intricate organ. How do surgeons like yourself learn to treat Surfer’s Ear effectively?

We train and learn ear surgery by ‘operating’ on donated human temporal bones – that quarter of the skull that houses the ear structures – and these never have exostoses. And unless surfers start donating their temporal bones after they die, very few trainees will ever get to do a case or even see one done. So many ENT surgeons learn the skill after qualifying by tackling the operation with the assumption that it is an easy operation. It is anything but easy. Many of us learn ‘the hard way’ as I did, having bad scares and close calls with our patients. It is a very humbling procedure. Both my patients and I were lucky.

How can Surfer’s Ear be prevented? What are the precautions to take? Should we all be wearing waterproof ear muffs?

Move to Durbs! Avoiding the wet-cold-windy cycle is the answer, especially in cold water. Wearing a hoodie is good, as is wearing earplugs. SurfEar makes an expensive but hear-through earplug that at least lets you hear the cries of ‘Shark!’

Is there a “miracle” cure? Or do we need to whip out the power tools from the garage?

Keeping narrow ear canals dry and using other methods like alcohol drops or waterproofing drops will help minimize the consequences, but no, surgery is the only cure and NOT WITH POWER TOOLS!

WestCoast0734Ewing

More precautions, more barrels?

What are the conventional ways of treating / operating on a patient with Surfer’s Ear?

In the early days of ear surgery surgeons used chisels to remove bone. The invention of modern surgical drills saw the use of chisels fall away, and for many years ENT surgeons have relied on drills to remove exostoses. There are problems with this method used for surfer’s ear.

What are the issues with conventional methods?

The first is that ear drills make a lot of noise and this noise transmitted into the skull and cochlea may damage hearing.The second is that the drill hand piece is pretty big, and the surgical incision needs to be big to enable the surgeon to see what he is doing.The third is that the drills require the use of several different drill bits of different sizes and cutting techniques, and these are single use, throw away items at anything up to R2500 a pop.The fourth is that a drill bit rotating at 40 000 rpm can easily snag on delicate canal skin and shred it, leaving a larger bony defect that takes much longer to heal. The fifth is that this surgery takes a long time – up to three hours an ear. Operating theatre time is around R175 a minute, excluding consumables. Do the math!

Namibia1696Ewing

There’s more than one thing surfers can chisel. Unidentified SA surfer performs small miracles on a Namibian bomb…

So surgery is the only option? Can Surfer’s Ear come back to crack us, after a successful surgery?

Yes, and unfortunately they can and do grow back. A young surfer who gets them at a young age and carries on surfing may well get them again. It’s not unusual for lifelong surfers to have surgery several times.

What are the best alternatives to the “drill” method in your opinion? Why is this method, your method, better?

There is a better way to do things than the conventional fashion. The first step is to find a surgeon who has gone back to using the chisel method.

The advantages are:
1. No incision, or only a small incision at the front of the ear, not the back.
2. No costs using expensive drill bits
3. Significantly faster surgery – 2 and 3 add up to considerable cost savings on the hospital bill
4. Both ears can be done at the same time
5. Healing should be significantly faster, back in the water as soon as two weeks after surgery in optimum cases

JBay1681Ewing

Surfer’s Ear doesn’t have to hold you back from those tubes…

Any advice for surfers with exostoses or surfers who brave brain-numbing water frequently?

Having the surgery as soon as exostoses is becoming a problem and not waiting until complete closure makes it far easier for the surgeon and usually there is a far quicker healing time. One almost has to look into the future and get the surgery done before it becomes too much of an issue for both doctor and patient. My advice to surfers with Surfer’s Ear is to find an ENT surgeon who is experienced, enjoys the surgery, uses this method (the chisel method) almost exclusively, and offers surgery on both ears at once.

For More Info Contact Dr Martin Young ENT Practice Knysna Here: www.drmartinyoung.com / Knysnaent@gmail.com / @MartinYoung

All Images © Greg Ewing (unless otherwise specified)

15 Comments

  1. Kirk
    31 January, 2018 at 4:52 am · Reply

    Dr Young, thank you! Great advice. Had both my ears drilled in 1985 and had complications in left ear that was 98%+ closed. Bone was pushing against ear drum and ended up needing subsequent skin graft to ear drum. Lots of hearing loss. Left ear is closing again and looking at THIRD surgery to correct. Your article is a good reminder to get surgery sooner than later from a VERY EXPERIENCED EXPERT ENT!
    Thank you! Capt. Kirk – ( 57 yr so cal waterman)

  2. Archie
    26 July, 2018 at 2:05 am · Reply

    Thankfully never got a surfers ear. Very lucky, minding that I’ve been surfing for years in NorCal without plugs, never liked the experience. But after my 3rd friend had to do a surgery I decieded to wear plugs. Still don’t like them.
    Me and a couple of my close firends have been working on a new gen earplugs. Check em out. http://xbuds.co
    Would love to hear your feedback!

  3. Julian
    14 September, 2018 at 6:14 pm · Reply

    I live in San Diego and started surfing when I was 12 years old. I had developed surfers ear very fast and at the age of 32 my ear was over 90% closed. I am 45 now and after a 12 year hiatus from surfing due to relocation I am now back to SD and started surfing again. It didn’t take long to get my first ear infection and after a month of it having gone away, a new one is starting to happen. I need to find a ENT locally that can handle this with the chisel method and would definitely like to have both ears done at the same time. Anyone have recommendations for a good doc?

  4. Douglas Hetzler
    31 October, 2018 at 5:36 am · Reply

    Dr. Andrew Beros is experienced in using the chisel technique for removing ear canal exostoses and has a medical practice in San Diego. Look him up.

    Doug Hetzler, MD, FACS

  5. Richard Very (required)
    6 January, 2019 at 9:40 pm · Reply

    Hi there . I have surfers ear pretty bad and it’s surgery time. Problem is I am on the east coast of the U.S. and when looking up a Dr. to do this ‘up to date’ procedure I seem to be having trouble. Only find Dr.s far away in surfcentric zones. Can one of you Dr.’s let me know of someone ? I am in Massachusetts . My ears are important so I’d fly to Cali in a heartbeat if that was my only option. I’m going to be very single soon probably. My girlfriend is overly sick of me saying ‘What ?! ‘ EVERY minute. I think we literally don’t even know we’re saying it so frequently. Please try to save me and my relationship. Thank you, Richard Very(richardvery68@gmail.com)

    • Mike P
      11 April, 2022 at 7:17 pm · Reply

      Did you find someone on the east coast?

  6. Michael Bufo
    8 June, 2019 at 1:10 pm · Reply

    I fly out from Maine to see Doug Hetzler in Soquel CA and it was totally worth it.

    • Jim Berg
      27 February, 2020 at 8:23 am · Reply

      How long do you have to wait to fly after surfers ear surgery?

  7. g l smith
    14 June, 2019 at 10:08 am · Reply

    Sassall ear drops by CoreNaturopathics ,Australia, best there is. These drops after every surf and a Gath hat have kept the drill away from my ears after 45 years of surfing cold water.

  8. Ryan Bugsy Heathcote
    26 June, 2019 at 7:00 am · Reply

    As a lifelong surfers ear sufferer, I was stoked to stumble on a rather unknown cure.. After deciding to use raw logic to try and sort this age old problem out I got some amazing results by using tumeric powder in my ear recently… I just lay on my side and poured a hefty amount into the old Gulliver ducts until they were full to the brim and waited in hope after this one black River come down at the so called blue beach in Sri Lanka.
    No infection has since lasted more than a day and I don’t think ill need any other cures after this, as it has cured every infection since and my ear canals seemed to be getting healthier and I’ll only get a slight blockage here and there and have actually stopped needing to use plugs!
    Yew! Stokin’!

    • Tracy Sage
      7 January, 2020 at 9:33 am · Reply

      Do you have the boney growth too? if so, Has is helped make it smaller? or just not get infections?

  9. Ron miilkName (required)
    15 August, 2019 at 9:43 pm · Reply

    Tumeric! I used to drive with window open but finally just had my 2nd ear done after 50 years using the flap method
    3 weeks out tinnitus worse and lost sense of taste?

  10. kathy Fisher
    17 November, 2019 at 10:46 pm · Reply

    Hi all, wave bashed my ear, perforated my ear drum. Had the surgery for surfers ear aswell as tympanic repair. Still deaf after a year, loss of taste and numbness ongoing. Constant ringing. Not impressed by any of the results. Kathy Cape town

  11. Gary Reedy
    10 August, 2020 at 11:55 pm · Reply

    Thank you Dr. Hetzler! How can I locate others in Northern California who are competent with the chisel technique? Not that I would not love for you to do it … just thought you (or others here) might offer a bit of an updated Directory. I am located in Grass Valley (Sacramento is close). Incidentally, I have advanced bilateral exostosis from a career snorkeling rivers and creeks to survey fish, as well as a lot of whitewater kayaking, mostly in winter.

    • MikeP
      11 April, 2022 at 7:22 pm · Reply

      Did you ever find someone in Norcal? Please let me know. Thanks.

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