Surfer's Ear

Surfer's Ear is the common name for exostosis (abnormal bone growth) within the ear canal. Over time irritation from cold wind and water cause the bone surrounding the ear canal to develop lumps of new bony growth which constrict the ear canal. The condition is so named due to its prevalence among cold water surfers. Orange County Register columnist, world champion surfer and sufferer of this condition, Corky Carroll published his research. ^[1] Surfer's ear is not the same as swimmer's ear. The condition is not limited to surfing and can occur in any activity with cold, wet, windy conditions such as kayaking, sailing, diving, etc. Most avid surfers have at least some mild bone growths (exostoses), causing little to no problems.^[2] The condition is progressive, making it important to take preventative measures early, preferably whenever surfing.

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Etiology

The majority of patients present in their mid 30s to late 40s. This is likely due to a combination of the slow growth of the bone and the decreased participation in activities associated with surfer's ear past the 30's. However surfer's ear is possible at any age and is directly proportional to the amount of time spent in cold, wet, windy weather without adequate protection.

The normal ear canal is 7-12mm in diameter (about the width of a pencil). As the condition progresses the diameter narrows and can even close completely if untreated, although sufferers generally seek help once the passage has constricted to 0.5-2mm due to the noticeable hearing impairment. While not necessarily harmful in and of itself, constriction of the ear canal from these growths can trap debris, leading to painful and difficult to treat infections. To visualize what this looks like, imagine a water pipe that slowly has sediment build up on the walls of the pipe. As the deposits grow larger, the pipe's diameter becomes constricted and effectively becomes a pipe of smaller diameter.

Symptoms

• Decreased hearing or hearing loss, temporary or ongoing
• Increased prevalence of ear infections, causing ear pain
• Difficulty evacuating debris or water from the ear causing a plugging sensation

Treatment

Traditionally surfer's ear has been treated by exostectomy wherein a small incision is opened behind the ear and the bone growth is removed using a surgical drill. Here is what ten time world champion surfer, Orange County columnist and exostosis sufferer Corky Carroll published.^[3] During recuperation it is extremely important not to return to the water for at least six to eight weeks to avoid infection or complications. The operation is performed under general anesthesia and can cost several thousand dollars per ear.

Though technically more difficult, some doctors now use extremely small chisels and enter directly through the ear canal. This lessens the noise (and potential hearing damage) as well as providing faster recuperation as the procedure is less invasive.^[4] Bone removal by the chisel method does not prevent new growth, therefore unprotected exposure after treatment can lead to some individuals needing to have two or three operations to the same ear.

Recent advances of laser removal and quiet diamond micro drills through the ear canal eliminate the need for an incision behind the ear, lessens the risk of noise damage, and eliminates re-growth of exostoses. It is technically more difficult and requires the skills of a specially trained otologist. That's a board certified ear, nose and throat surgeon with an additional one to two years of ear surgery, or otology, fellowship training. Typically, surfers who have this approach return to water sports in less time than previously; usually four to five weeks.

Alternative Treatments

Mild or asymptomatic cases of surfer's ear have been known to improve without intervention in cases where the ear is no longer exposed to cold or wet windy conditions. The process of bone growth reverses and the excess bone is gradually reabsorbed. However this is not universally accepted, some believe that any existing exostosis will remain if untreated.

Outer ear infections and plugging with debris lead to many of the problems with pain and hearing loss. While protecting against cold water and taking care to dry the ears after ocean exposure reduce the infections and clogging, the bone formations themselves aren't believed to generally dissolve or go away on their own.

Prevention

• Avoid activity during extremely cold or windy conditions.
• Keep the ear canal as warm and dry as possible.
• Surfplugs Custom Ear Protection
• Ear plugs
• Neoprene hood
• swim cap
• Surfmuff

Trivia

• When exostoses are completely removed there is little chance of recurrence requiring repeat surgery in the future.
• In general one ear will be much worse than the other due to the areas prevailing wind direction or the side that most often strikes the wave first.
• Just as it's possible motorcycle helmets increase nonhead related injuries due to increased risk-taking, the widespread use of wetsuit hoods, caps, and neoprene bands has allowed people to surf in much colder waters, which probably has increased the incidence and severity of surfer's ear for those that don't properly protect their ears.
• Cold water surfers experience surfer's ear at about six times the rate of warm water surfers.

References

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 + 1. Carroll, Corky, (2007) http://ear-hearing-doctors.com/images/Article_1.pdf  
 + 2. Wong, et al., (1999). Prevalence of external auditory canal exostoses in surfers. Archives of Otolaryngology, 
 +    Head and Neck Surgery, 125, 969-972.
 
 + 3. Carroll, Corky, (2007) http://ear-hearing-doctors.com/images/Article_3.pdf  
 + 4. http://www.santacruzmedical.org/surfersear.html
 + 5. Ask the Expert(2005)http://www.ocregister.com/discoveroc/valuing-fathers-robertson-1272041-sweet-board