Surfers ear ( otherwise known as “exostoses”) is a condition where the ear canal is narrowed by bone which grows slowly in the ear canal over a long period of time. The bone grows in lumps, which form bulges, behind which water may be trapped. The new bone growth is stimulated by exposure to cold water and cold air. Surfers ear is therefore common in New Zealand, the West Coast of the U.S. and the Coast of Australia. Given enough time and enough cold exposure, the bony lumps (known as exostoses) eventually completely close the ear canal off, resulting in hearing loss and persisting infection.
Swimmer’s ear is usually caused by a bacterial infection, but can also be caused by fungus. You are more likely to get swimmer’s ear if you regularly get water in your ear that doesn’t drain out. This can happen when you go swimming or wash your hair. This is because the wet ear canal softens the skin, which makes it easier to get infected. Damage or irritation to the ear canal can also increase the risk of infection. This can happen through:
- cleaning the ear canal with a cotton bud or your finger tips
- chemicals such as shampoo or hair dye irritating the skin
- narrow ear canals
- eczema or dermatitis breaking the skin’s protective barrier
- middle ear infection
- wearing hearing aids
See your doctor if you think you might have swimmer’s ear. Your doctor will ask you about your symptoms and then use a special device called an otoscope to look inside your ear. This lets them to check your canal, and examine your ear drum to see if it is damaged or torn.
Your doctor will prescribe you with medicated ear drops to fight an infection and reduce any swelling of the ear canal. If possible, ask someone to put the ear drops in for you — it is easier than trying to do it yourself. In severe cases, swimmer’s ear is treated by inserting a small sponge called a wick into the ear canal. This helps to make sure the drops get inside the ear canal.
While you are using the antibiotic ear drops, you should also:
- avoid getting your ear canal wet — check with your doctor when you can go swimming or participate in water activities
- wear a shower cap while bathing or showering
- avoid inserting anything into your ear canal, including cotton buds
- avoid scratching or touching your ear
If you have pain, try over the counter pain medicine such as paracetamol or ibuprofen. These medicines are not suitable for everyone. Speak to your healthcare professional or pharmacist before taking these medications if you are unsure.
In most cases, treatment will improve symptoms within 2 to 3 days. Most people will have few or no symptoms by the end of the first week of treatment. If your symptoms have not improved by then, see your doctor.
Some exostoses do not require any treatment, but once these have been diagnosed it is wise to protect the ears from cold water exposure using ear plugs (such as ‘Surf Ears’ or ‘Docs Pro plugs’ and/or a neoprene headband or hood. These may slow down the growth of the exostoses. Water blockage may often be successfully managed using “Vosol” or alcohol ear drops after swimming other water exposure. These displace moisture and help dry and/or acidify the ear canal, reducing the risk of ear canal infection. If the exostoses cause ongoing problems with ear water blockage (water trapping) or ear infections they may be best removed.
This is performed under a general anaesthetic (you are asleep). It is usually done on a “day stay” basis, or with one overnight stay at Gillies Hospital. There are various alternative surgical options, and we would discuss your preferences and plan together the best approach for you. The simplest way to remove these is a “chisel” technique endoscopically and /or microscopically through the ear canal. This is available for people with at least a 3 mm gap between the exostoses. If the gap is too small ( ie: if the exostoses are too large) a cosmetic incision tucked in immediately behind the ear or immediately above the ear hole is needed for safe access. With this alternative approach, a chisel technique, and/or a “Piezo” drill and/or a micro drill may be used. A light dressing and antibiotic ointment are used to promote perfect healing. The hearing is a bit muffled for 1-2 weeks only.
The ear should be kept perfectly dry until healed. Time before going back into the water, ranges from 4-12 weeks. Hearing tests are performed pre operatively post operatively. At your consultation, we can discuss whether you would like both ears done– which would then be spaced a week or two apart, and in this situation a hearing test is done before the second op.
There is only very modest discomfort following the surgery for exostoses– which is usually easily managed with paracetamol and an anti- inflammatory ( such as celecoxib/nurofen etc), and taken only as long as needed. I advise avoiding heavy lifting or straining for two weeks afterwards, which may mean being “off work” and “no gym” for some people. Plenty of walking for light exercise is fine. It’s rare to need this procedure done twice, if the ears are well protected from cold afterwards, however I have had to perform revision surgery many times for surfers who have had their surgery done elsewhere.
You can prevent ear barotrauma by keeping your eustachian tubes open. Ways to do that include:
- If you have a cold or allergies, take a decongestant about an hour before you fly. A nasal spray or an antihistamine could help, too.
- Special plugs designed for air travel can slow pressure changes and give your ears time to adjust.
If you’re a diver, try these things to protect your ears:
- Equalize your ears before your dive and while going down into the water.
- Go down feet first — it can make equalizing easier.
- Look up — extending your neck can open your tubes.
- Get back to the surface slowly if you feel pain — continuing your dive can injure your ears.
- Don’t dive if you have any sinus or upper respiratory symptoms.
If you have ear pain or itchiness, have discharge from your ear or experience any other symptoms of swimmer’s ear, see your doctor. See your doctor if you notice you can’t hear well. It is important to start treatment early so the infection doesn’t get worse or spread. If you still have symptoms after treating swimmer’s ear for one week, go back to your doctor for review.