by Corky Carroll
It’s time for my annual “Surfers Ear” column featuring the incredible Dr. Carol Jackson, leader in the care and treatment of this condition. The following is direct from the Doc’s mouth.
“Despite jumping up and down, head tilting, and tapping the ear; surfers often experience ear blocking when benign bony nodules called exostoses grow to occlude more than 70% of the canal diameter. Then they often trap water and debris. “My ears plug for hours or days after surfing and I can’t get them unplugged!”
Exostosis forms slowly over years due to mother nature’s attempt to protect the eardrum from the forcible rush of cold water against the tympanic membrane. Forceful water, as in actively wiping out, is the strongest growth stimulus followed by how cold the water is. Exostoses don’t form in swimmers, divers or wind surfers who have not also surfed for years.
At large sizes in advanced severity, they muffle hearing and disrupt the ear’s normal self-cleaning and protective wax coatings. Instead, infectious yeast, fungus and bacteria, plus sand and dead skin plug the ear becoming trapped in crevices between the large rounded exostoses. The material becomes a cheesy consistency which won’t drain or flush off. This often leads to an acute or chronic infection of the sensitive ear canal skin called “swimmer’s ear.” Occasionally, a rip-roaring acute infection will cause the kind of severe pain that makes a grown man cry!
Preventive tips include custom vented swim plugs that allow sound to be heard while wearing them! They float, come in bright colors, even with glitter, can be put on a lanyard, and are rarely lost in the water. Also helpful are portable surfer’s ear dryers available on the internet for use after water sports to evaporate retained water. They’re portable, plug into vehicle power ports and work on batteries. No water, no germs!
When plugging is frequent or hearing is muffled, it’s time to see an otologist with an office microscope. That’s an ear specialist for debris clearing, treatment of the underlying skin infection and stepped-up care. When bone blockage is over 80%, it’s time to consider getting them removed. Laser-assisted microsurgical excision is minimally invasive and always definitive. No need for repeat removals. If you’ve had repeated removals before, the exostoses probably weren’t completely removed or the bases weren’t sufficiently treated.
Laser-assisted removal is outpatient and now better than ever with return to most non-water activities the next day. There is surprisingly minimal postoperative discomfort. External skin incisions are no longer necessary so there are no visible scars or pinna numbness and protrusion. There have been no repeated removals with this technique in twenty years of follow-up. It’s a permanent solution to put “surfer’s ear” in the rear view mirror. Since recovery and healing is faster under age 70, it’s best to have them removed when they are 75 to 90 percent occlusive. Return to water with precautions is usually in four to six weeks; sometimes longer if occlusion is more than 90% preoperatively.
If you feel plugged or it seems like some people mumble, you could have reduced hearing either due to surfer’s ear or unrelated such as from prior loud sound or some age-related changes over age 60. People with ringing in the ear, dizziness, or imbalance may have unrelated ear conditions that would benefit from separate assessments and treatment such due to a benign tumor or elevated inner ear fluid pressure, called hydrops. Oral medications, balance therapy, or current technology hearing aids may be indicated. There can be more than one cause of ear symptoms at the same time which can be different in ear each.
Learn about the severity of your exostosis on camera and receive an ear checkup. It’s wise to see an ear doctor who uses an office microscope and can show you your ear, possibly photograph it, for you to understand. Have a hearing test by an audiologist in a sound booth for accurate assessment and determination if any reduction is related to exostosis or from an unrelated condition.
At home, to try to ease mild itching, discomfort, or plugging it’s safe and can be soothing to instill and massage in a few drops of original plain baby oil while lying on your side with the affected ear up twice a day. For any ear discomfort or drainage, keep the ear clean and dry. First aid measures include Tylenol PM. Don’t use over-the-counter chemical preparations or devices, rubbing alcohol or soap, swabs or flushing. These measures risk pushing material deeper or causing more irritation and swelling.
To the younger generations of surfers and everyone with less than 70% canal occlusion, remember that exostosis growth can be halted or completely prevented by ear plugs! Any plug that’s comfortable enough to consistently wear that keeps most of the water out most of the time will keep your ear canals open. Over the counter moldable silicone or shallow ear plugs are advised over long hotdog or Christmas tree plugs. Those can rub on deep thin skin.
Take care of your ears! We only have two, they don’t re-grow and they cannot be replaced!”
You can reach Dr. Jackson right here in Newport Beach at (949) 574 7744.