November 11th, 2018

Surfers Ear 2018

Each year at this time, with Winter coming on and the water getting colder, I do a story on dealing with taking care of your ears if you are a surfer. My “go to’ expert on this subject is Dr. Carol Jackson of the Ear and Balance Clinic in Newport Beach. She is the leader in treating surfers ears and there is nobody I would trust my ears to other than her. I just did an interview with Dr. J that I think all of you that surf in the winter will find useful.
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Q: Why does my ear plug up after surfing?
A: As the bony “speed bumps,” called exostoses, with surfer’s ear grow, water and debris flowing in as well as shedding skin cells from the ear drum and canal migrating out can get trapped. With growth, the ear canal opening gets smaller and eventually the canal pathway gets jammed.
Q: What’s the best way to prevent surfers ear or to stop mine from getting larger?
A: Keeping forceful flow of cold water out of the ear is the only way. Ear plugs that stay in are the best prevention, although a hood or Velcro headband can be effective if worn consistently. How hard the water is forced into the ear and how cold the water is are the two triggers that cause surfers ear.

Q: Which ear plugs are the best? 
A: I’m often asked this question and my answer is always “the ones that fit you well, are comfortable enough that you’ll wear them, and that stay in.” Having said that, I favor short to medium length plugs; not so much the long “hot dog” or “tree-shaped” plugs which can rub on exostosis skin and push canal debris in deeper. For those who surf regularly, custom plugs are the best for fit and comfort. Since they last many years they’re cost-effective. They float and come in bright colors. They can be made with a lanyard and washed with soap and water.

Q: When should I see an otologist ear specialist?
A: If you are or have been in the ocean often, now is good in order to plan preventive care since there’s no method, except removal, to shrink exostoses. Symptoms of advanced exostosis that should prompt an otologist’s micro-exam include water plugging of your ear, discomfort, reduced hearing or pain with infection. Unlike emergency rooms, urgent care centers, or most general ENT offices, otologists have office operating microscopes connected to a display monitor to show you your problem and also to remove plugging debris. It’s critical that treatment medications can get down to the affected skin and deep canal near the ear drum.

Q: What’s the difference between swimmer’s ear and surfer’s ear?
A: Swimmer’s ear is an infection of the ear canal skin and soft tissues. It also occurs in non-swimmers and is made worse by using cotton swabs which remove protective wax and skin oils. Surfer’s ear, exostosis, is a condition of abnormal bone formation, rounded lumps that fuse and grow slowly. It’s nature’s attempt to protect the ear drum from repeated cold water flushes that has gone too far! They can occur together needing prudent treatment..

Q: When is exostosis removal necessary?
A: Since neither time nor other treatments will shrink exostoses, they need to be removed when they’re causing problems; usually that’s when they’re blocking 85% or more of the ear canal opening to the ear drum. That’s when they cause plugging or infections. When they are smaller, diligence to wearing plugs, air evaporating retained water, and promoting healthy canal skin can halt growth and allow reasonable management.

Q: If I need exostosis removal, what’s involved?
A: Removal procedures are usually outpatient under general anesthesia. Most patients have minimal discomfort afterwards. Most can return to their usual non-aqueous non-strenuous activities in a couple of days and return to water with precautions in four to six weeks. Individual healing varies depending in part on the severity of exostosis, technique used, the patient’s general health and compliance with post-operative care.

Q: What’s the best removal method?
A: I’m often asked this question by patients who are considering removal. My answer is an adage among physicians, “the way that works best in my hands.” Doctors develop preferences based on training, advances, theory, experience and results. Today, there are basically three: 
(1) behind-the-ear approach with quiet diamond air drill removal; the standard for safe removal developed and used by otologists, specialists who treat only ear disorders, for some 50 years. 
(2) chisel mallet separation in planes between exostoses and normal bone which is still used by a few general ENT doctors that also treat nose, sinus and throat disorders. The use of small chisels the surgeon taps with a small hammer was used in ear surgery 100 ago; before diamond air drills and lasers were developed for modern precision micro ear surgery near the ear drum and nerves.
(3) laser-assisted removal through the ear canal, with diamond air drill and grafts; my own developed preference used for 15 years, when feasible.
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For more info or to make an appointment to see Dr. Jackson call (949) 574-7744

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