Definitions

surfer's knob

Surfer's Ear

Surfer's Ear is the common name for exostosis, abnormal bone growth, within the ear canal. Surfer's ear is not the same as swimmer's ear.

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. Cold water surfers experience surfer's ear at about six times the rate of warm water surfers.

The condition is not limited to surfing and can occur in any activity with cold, wet, windy conditions such as kayaking, sailing, diving. Most avid surfers have at least some mild bone growths (exostoses), causing little to no problems. The condition is progressive, making it important to take preventative measures early, preferably whenever surfing.

Etiology

Symptoms

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.

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. When exostoses are completely removed there is little chance of recurrence requiring repeat surgery in the future.

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, usually three to four weeks, as the procedure is less invasive.

Recent advances of laser removal and quiet diamond micro drills through the ear canal eliminate the need for an incision behind the ear and lessens the risk of noise damage. Typically, surfers who have this approach return to water sports in less time than previously; usually four to five weeks.

Unprotected exposure of ear canals to cold water and wind after treatment can lead to regrowth of bone and the need for repeated operations on the same ear.

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 may reverse and the volume of bone may gradually reduce. 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

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.

The Orange County Register columnist and world champion surfer Corky Carroll has published some basic information from interviewing Dr. Carol Jackson on the topic of surfer's ear.

  • First and foremost, prevention, or the minimization, of the onset of surfer's ear is best served when ear plugs are not left in one's pocket.
  • The use of either alcohol or hyrdrogen peroxide should be avoided as it dries and irritates the skin
  • The use of a prescription water-repelling coating agent with a topical steroid to reduce inflammation

Other recommendations:

  • Avoid activity during extremely cold or windy conditions.
  • Keep the ear canal as warm and dry as possible.

References

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