Surfers ear ( otherwise known as "exostoses") is a condition where the ear canal is narrowed by bone which grows slowly in the ear canal over a long period of time. The bone grows in lumps, which form bulges, behind which water may be trapped. The new bone growth is stimulated by exposure to cold water and cold air. Surfers ear is therefore common in New Zealand, the West Coast of the U.S. and the Coast of Australia.
Given enough time and enough cold exposure, the bony lumps (known as exostoses) eventually completely close the ear canal off, resulting in hearing loss and persisting infection.
I am one of the very few surgeons with a particular expertise and experience in managing Surfer's ear/Eostoses, and I treat patients who come from all around New Zealand.
|
|
|
|
| Exostoses | Normal Ear |
Symptoms
Water gets stuck in the ear-those affected may need to shake their heads or hop vigorously to clear the ear canals
Ear canal infections - these may become increasingly common as the exostoses grow. Ususally they follow water exposure through swimming. The narrowness of the ear canals may make these infections slow to settle. The infections are treated with antibiotic ear drops and sometimes oral antibiotics.
Reduced hearing - this is a late and uncommon problem-- however the hearing may be temporarily reduced when the ears are infected
Management
Some exostoses do not require any treatment, but once these have been diagnosed it is wise to protect the ears from cold water exposure using ear plugs (such as 'Surf Ears' or 'Docs Pro plugs' and/or a neoprene headband or hood. These may slow down the growth of the exostoses.
Water blockage may often be successfully managed using "Vosol" or alcohol ear drops after swimming other water exposure. These displace moisture and help dry and/or acidify the ear canal, reducing the risk of ear canal infection.
If the exostoses cause ongoing problems with ear water blockage (water trapping) or ear infections they may be best removed.
Surgical Treatment
This is performed under a general anaesthetic (you are asleep). It is usually done on a "day stay" basis, or with one overnight stay at Gillies Hospital.
There are various alternative surgical options, and we would discuss your preferences and plan together the best approach for you.
The simplest way to remove these is a "chisel" technique endoscopically and /or microscopically through the ear canal. This is available for people with at least a 3 mm gap between the exostoses. If the gap is too small ( ie: if the exostoses are too large) a cosmetic incision tucked in immediately behind the ear or immediately above the ear hole is needed for safe access. With this alternative approach, a chisel technique, and/or a "Piezo" drill and/or a micro drill may be used. A light dressing and antibiotic ointment are used to promote perfect healing. The hearing is a bit muffled for 1-2 weeks only.
The ear should be kept perfectly dry until healed. Time before going back into the water, ranges from 4-12 weeks.
Hearing tests are performed pre operatively post operatively. At your consultation, we can discuss whether you would like both ears done-- which would then be spaced a week or two apart, and in this situation a hearing test is done before the second op.
There is only very modest discomfort following the surgery for exostoses-- which is usually easily managed with paracetamol and an anti- inflammatory ( such as celecoxib/nurofen etc), and taken only as long as needed. I advise avoiding heavy lifting or straining for two weeks afterwards, which may mean being"off work" and "no gym" for some people. Plenty of walking for light exercise is fine.
It's rare to need this procedure done twice, if the ears are well protected from cold afterwards, however I have had to perform revision surgery many times for surfers who have had their surgery done elsewhere.
Here are some examples of ears which have been widened.
 |
 |
|
| Pre op right ear | Post op right ear |
 |
 |
|
| Pre op left ear | Post op left ear |
Risks of surgery
Fortunately, in experienced hands these are all very rare indeed. These may include:
- General Anaesthesia- In general, most people having this operation are fit, active and well. For those with no other medical conditions, the risk of a life threatening consequence is less than the risk of driving to the clinic, and less than the risk of flying- something most people will do without a second thought. Everyone is assessed and advised pre operatively by a specialist anaesthetist.
- Scarring- this may very rarely occur behind the ear or in the ear canal.
- Ear drum or hearing bone damage. Ear drum damage is readily repaired "on the spot".
- Hearing loss. In any ear operation there is a risk of approximately 1% of this occurring, due to drilling noise or other factors. This may be measurable on a hearing test, but is not necessarily always detectable by the consumer. Since 1997 when I first started operating in private practice, I have not had a single case where a patient mentioned hearing loss after exostosis surgery.
- Tinnitus (ringing in the ear). This is not uncommon (but rarely troublesome) in the few weeks post operatively, and almost always resolves.
- Facial nerve injury- resulting in a partial or complete facial paralysis. This is described in otolaryngology journals, but in well over a thousand operations I have performed on the ear, this has never occurred.
- Ear Numbness- this is temporary, and not troublesome, following an incision behind the ear. It's better to treat exostoses earlier rather than later, so this can be avoided.
- Ear prominence- this is rare, but may occur after incisions behind the ear. It usually , but not always resolves completely. Again, it's better to deal with exostoses earlier, to avoid this.
Benefits of surgery
- No water trapping-- the ears clear completely and easily
- Substantially reduced risk of ear canal infections
The information on this website is for general guidance only. For specific advice relating to your exostoses, please call 631 1965 to make an appointment. Telehealth/Video consultations are available if you have good quality photos of your ears.
If you live far from Auckland (or even if you do live in Auckland), and your doctor or audiologist can take photos of your ear canals, I'm very happy for you to E mail these to me (This email address is being protected from spambots. You need JavaScript enabled to view it.) to give you general guidance to see whether your exostoses might be best removed, and what technique might suit you best.
The earlier symptomatic exostoses are treated, the simpler the surgery and the quicker the healing.
Reviewed Dec 2022