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…
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?
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.
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.
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!
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!
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
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.
All Images © Greg Ewing (unless otherwise specified)