Surfer’s Ear

Surfer’s ear affects more than surfers, and it is not to be confused with swimmer’s ear. The latter is an infection of the outer ear canal typically caused by water left in the ear after swimming or by putting cotton swabs, fingers and other objects into the ear that damages the thin skin of the ear canal. Surfer’s ear often includes an infection of the middle ear canal.

• Exostosis is the formal name for surfer’s ear
• It’s a condition that could lead to hearing loss

Surfer’s ear is abnormal bone growth occurring in the ear canal. The extra bone causes constriction and thickening in that area. When this occurs, those who expose themselves to cold water, such as surfers, swimmers and divers, may find that water trapped in the ear canal. It either flows inside when they are in the water or windy conditions may push the water into the ear canal.

Early symptoms of exostosis include ear infections, water trapped in the ear canal, and some minor hearing loss. Another symptom is a decrease in the size of the ear canal. Average ear canal size is roughly the diameter of a number two pencil. As surfer’s ear progresses, that size reduces by half or more. The abnormal bone growths are small and bony lumps inside the external ear canal. Cold water and air cause the thin layers of abnormal bone to grow. Because the growth rate is slow, these lumps take years to develop, which is why most sufferers of exostosis are in their mid-30s and why most people don’t notice a problem until the symptoms are more serious. Sufferers typically are affected in both ears, but the rate of growth may not be the same in each ear.

One potential problem associated with surfer’s ear is a middle ear infection. Middle ear infections, also known as acute otitis media, are very common, especially among children. However, when the infection is part of surfer’s ear, it is more common among adults in their mid-30s and is a side effect of a different problem.

When the ear canal gets blocked bacteria can grow in the retained water in the ear canal and cause ear canal infections which may become persistent or recurrent. Another problem is conductive hearing loss. Sound must travel from the outer ear to the middle and inner ear, but with the constriction caused by abnormal bone growth, sound is blocked. This results in a temporary type of hearing loss. Exostosis, once developed, stays forever without medical treatment.

Small exostosis that does not bother the patient may not require treatment. After time passes and the exostosis grows larger, the patient will require medical intervention. For patients experiencing frequent ear infections, ear pain or some hearing loss need to see an ear sub-specialist who works with ear bones and is experienced in surgery to remove exostoses.

Two surgical options exist for surfer’s ear. One involves the doctor making an incision behind the patient’s ear and using a drill to remove the bony growth. The other method involves the doctor using a micro chisel inside the ear canal to eliminate the bony growth. With this procedure, a thin sheet of silicone placed inside the ear protects the treated area after surgery. Three weeks after surgery, the silicone is removed. Recovery is quick for both surgical procedures. Ear drops or oral pain relievers are usually all that is needed for any post-op pain or discomfort. Antibiotics are commonly prescribed to prevent infection and to keep the silicone moist. Patients should avoid cold water in the ear for up to six weeks after their surgery. Most patients have no further problem after exostosis surgery, but new growths may develop with exposure to cold water and air.

Since cold water and air create the problem of surfer’s ear, prevention methods include avoiding the conditions that cause exostosis. Avoid swimming, diving and surfing in very cold water. Other options are to wear over the counter, custom-fit ear plugs, swimming caps, and diving suits with hoods attached.