Dr Colin Brown - Ear, Nose & Throat Surgeon
Surfer's Ear "Exostoses"
Exostoses are smooth, bony bulges or knobs in the ear canal which are initially symptom free, but progressive growth causes water trapping in the ear which may lead to painful and difficult to treat ear canal infections. They are caused by cold water and air entering the ear canal which is protected by only a very thin layer of skin over the bone which grows with cumulative exposure to the cold. As this is a progressive condition, the time until symptoms develop depends on cumulative time spent swimming, surfing, windsurfing, water skiing and kite surfing. Typically, this affects men in their 30s onwards and because of our long coastline, is very common in New Zealand. Patients may present with difficulty clearing water from the ear, often having to resort to shaking the head or hopping. Water trapping predisposes to ear canal infections which may be very slow to settle as the ear canal is narrowed further by inflammation in the canal skin, making it even more difficult to clear infected debris. Usually temporary hearing loss and/or ringing in the ears may result until the infection settles. In the non-infected state, one may see multiple smooth, pale prominences in the canal.
Treatment is generally by prevention. This involves using ear plugs for all cold water sports. “Blu tac” works well, but “Doc’s Pro Plugs” (available from audiology clinics) generally allow one to hear better while wearing them. Audiologists can also custom make ear plugs. Neoprene head gear or “ear wraps” (also available from audiology clinics) are also both protective and may prevent loss of ear plugs. “Vosol” or 2% acetic acid in 70% surgical spirit ear drops are good to use after water exposure. Both help displace moisture and evaporate quickly, leaving a slightly acidic protective residue. A good alternative is a half and half mixture of gin or vodka and vinegar!
Otitis externa is treated with antibiotic steroid drops, and may also require the ear/s to be suctioned free of debris. Generally “Sofradex” antibiotic drops are a good first line, but if the bacterium pseudomonas is suspected (because of its green tinged discharge, odour, history of recent swimming pool use or because of a swab result) Ciproxin HC drops would be a good choice.
When is surgery needed?
Surgical treatment is necessary when the exostoses are symptomatic with water trapping or ear infections and not manageable with ear drops and or ear plugs. If the exostoses are large and if on-going cold water exposure is anticipated, surgical treatment may also be recommended. Many surfers don’t like wearing ear plugs and probably should have large exostoses removed before too many problems begin.
Surgery is a safe and effective treatment for exostoses and involves elevating the ear canal skin off the exostoses and then drilling them away. The skin is then replaced and held in place with a dressing while it heals. Operations are usually performed through a small incision tucked in behind the ear, and are generally “day stay” procedures. Discomfort is mild afterwards, with the main frustration for many being the need to keep out of the water for up to 8 weeks afterwards until the canal has completely healed. Limited surgery to remove the exostoses may need to be repeated later in life, but repeat surgery is very rare if a complete ear canal widening (canalplasty) is performed at the same time.
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