Surfer’s Ear: Prevention is Better Than Cure

02 . 12 . 17

As autumn ends here in Cornwall yet more neoprene is taken out of the backs of sheds and garages to help us keep surfing through the winter. We’ve been in thicker wetsuits and boots for a little while now, but the time of year for hoods and maybe even gloves is here. Alongside all of this neoprene, ear plugs are an oft-overlooked essential for surfing through the colder months. Truth be told, here in the UK regular surfers should be wearing them all year-round, although not many do. 

Why is that? 

Surfer’s ear is a condition that any regular water-users in temperate climates are at risk of developing, and don’t let the sexy “surfer” marketing tag fool you: the only way to reverse the loss of hearing and repeated ear infections that it causes is to go under the knife (which is actually also a drill or a chisel). The good news though is that it’s easily preventable.

“Surfer’s ear (exostosis) is a condition that, in years to come, we should see less of as knowledge of it and its preventability amongst surfers improves. Counterbalancing that however is the surge in popularity of surfing.”

Dr. Phil Flanagan – Cornwall, UK

What is surfer’s ear? 

The medical term for surfer’s ear is auditory exostosis, which comes from the Greek ex- ‘out’ and osteon ‘bone’. An exostosis is a benign outgrowth of bone on top of an existing bone, and in the case of surfer’s ear this bone growth forms on the bits of the skull that form the ear canal eventually blocking off the ear canal altogether. Bone takes a long time to grow, but a surfer can present with exostosis after as little as five years of regularly surfing in cold water.

Why do surfers get it? Auditory exostosis is most commonly caused by prolonged exposure to cold water and wind. It’s thought that the cooling evaporative effect of the wind on the water within the ear canal causes an increase in blood flow that stimulates the growth of the boney lumps. The effect of the wind might explain why in some parts of the world surfers have more advanced surfer’s ear on one side due to the prevailing wind direction at their local break. Surfers certainly aren’t the only group at risk of developing these boney growths; it can happen to anybody and other water users such as divers and sailors are also particularly susceptible, however surfers seem to be the highest risk group.

How is it treated?

Most surfers only find out that they have developed surfer’s ear when they go to the doctors complaining of repeated ear infections and gradual hearing loss. Because bone grows so slowly the slide towards surfer’s ear and hearing loss is gradual and often goes unnoticed until it has reached a critical point. Ultimately, the only treatment is surgery. This involves a specialist surgeon either using a tiny drill to remove the boney lumps, or using a surgical chisel to split the exostosis along its natural fracture lines and remove them, with there being several different techniques that the surgeon can use to access the ear canal and remove the skin that lines it in order to remove the exostosis. Whichever technique is used by the surgeon, recovery means time spent out of the water and there is no guarantee that the exostosis won’t start growing back once the patient gets back to surfing.

How to avoid or prevent surfer’s ear? 

Ear plugs and/or a wetsuit hood. Plain and simple. By preventing cold water from repeatedly flushing in and out of your ears, you’ll improve your chances of avoiding ear surgery in the future. Some water getting into your ear canal isn’t really a problem (it will be warmed to body temperature soon enough if trapped there), it’s the flushing in and out of cold water and the wind that causes the problem.

“The condition can be prevented by stopping the repeated ingress of cold water into the ears either with plugs or a hood. Despite this the use of protection has been poor in the UK. Our study of winter surfers’ awareness of exostosis in 2010 revealed that only 60% knew of its preventability, and only 54% used some form of protection. Knowledge of the condition was associated with a greater likelihood of using protection and I would therefore expect this figure to improve as more information is provided for the surfing population.”

Dr. Phil Flanagan – Cornwall, UK

These days ear plugs are far more advanced and don’t affect one’s hearing or balance in the way that they used to, and certainly not in the way that putting putty in your ears will. If you keep your surfboard, wetsuit gear, towel, wax and fins in the boot of your car, then there’s really no excuse not to add a pair of ear plugs to that kit list – of not for the summer then most definitely over the winter.

For expert medical advice regarding the diagnosis and treatment of auditory exostosis in Cornwall, contact Dr. Phil Flanagan at Royal Cornwall Hospital (Treliske).

If you’re interested in finding out more about surfer’s ear and how it is treated, there’s a deep dive into the topic written by Mat last year over on Surf Simply Magazine.

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