Surfer Ear | Exostosis Explained

The commonly called surfer's ear is the abnormal growth of the outer ear bone. Exostosis, a medical term, occurs due to repeated ear contact with cold water. That is why it mainly affects people who surf and refers to the surfer’s bone.

However, any activity that involves continuous and direct contact with water can cause this bone to grow; fishing, sailing, diving ...

The problem with exostosis is that bone growth causes the diameter of the ear canal to shrink, causing it to have difficulty draining water or wax. The remains of water in the ear cause the appearance of fungi and batteries that cause infections.

Ear infections are painful and require antibiotics in most cases. But, in addition, if the infections are recurrent, they can end up causing hearing loss.

What is the surfer's ear or exostosis?

Ear exostosis is the abnormal growth in the form of bumps of the bone of the canal. These bumps cause the duct to narrow partially in mild cases or completely in more severe cases.

Exostosis occurs as a response to prolonged exposure to cold water, which is why it is mainly suffered by surfers, swimmers, divers, and, in general, people who practice water sports. That is why the exostosis of the ear canal is commonly known as a surfer's or swimmer's ear.

When the exostosis is in its early stages, you can feel clogging, as if water had gotten inside, and when the narrowing is increasing it can cause difficulties to expel the wax from the ear, which can cause plugs. In the most severe cases, otitis, infections, and hearing loss are possible.

The way to prevent it, although it has not been proven, consists in the use of bath plugs in the practitioners of these sports, which slows its growth or if the exostosis has already appeared, its use can slow it down and also avoid the complications of complete plugging and otitis previously described.

If the exostosis does not cause problems, it is advisable to visit the specialist periodically to clean the earwax from the ear canal to avoid its accumulation and plugging, and infection. But if it is causing symptoms it is advisable to intervene.

Its intervention is carried out by surgery (canaloplasty) and consists of removing these new bone formations and leaving a sufficiently wide conduit so that there are no problems. It is an operation that is done directly through

the ear canal without the need to make incisions behind the ear and in this way, much faster and less painful recovery is achieved.

What are the symptoms of exostosis?

At the very beginning of the evolution, no discomfort is felt by the patient. As the exostoses grow, may appear:

Deafness and a feeling of blocked ears, especially after swimming; this sensation may be reversible after cleaning the AED.

Repeated otitis externa and pain.

Surfers and divers particularly affected

Surfers, divers, and other swimming enthusiasts are particularly affected by otitis externa. These people are generally well aware of the risks and take care to clean their ears after each swim. Not to mention that the fact of diving regularly for several years can, in the long term, cause the development of bony growths in the ear canal. The narrowing of the ear canal can then retain water and promote the development of bacteria and therefore recurrent ear infections.

If otitis externa is very painful, it is because the external auditory canal is a particularly fragile structure. It is the only place in the body where the skin is very thin, and it is directly stuck to the bone, without hypodermis favoring its sliding on the bone. The hypodermis is a layer of tissue that is usually found under the skin, but without this layer, the bacterial infection causes painful inflammation, directly in contact with the ear bone, which is particularly innervated.

Prevalence of this pathology

The prevalence of exostosis in people who surf has been analyzed in several studies, with a lot of variabilities, from 20.6% to 73.5% of surfers in the different studies, without taking into account the degree of severity.

The variability responds to the fact that these investigations have been carried out in different geographical locations, therefore, there are environmental differences. Differences in the design of the studies also influence, as seen in two studies carried out on surfers with the same environmental conditions. what is clear is that the prevalence of this pathology is very high and much higher than in the general population. It can affect people who are not surfers, but it is rare. Yes, it is very frequent, for example, in divers and swimmers.

Otitis externa or media?

In highly renewed waters such as the ocean, the risk of bacterial contamination is rather low. "But the still waters or those very frequented by bathers create the ideal conditions for microbial maceration", notes the doctor. Even more so when the water is hot.

The symptoms of otitis externa are easy to recognize. It is, first of all, intense pain in the ear that rapidly increases, like a toothache. To this can be added a discharge of pus as well as conductive deafness: it resonates in the ear and you can hear yourself speak. We hear less well because the liquid prevents sound from passing through. To differentiate otitis externa from otitis media (which affects the area behind the eardrum), just pull your ear: if this increases the pain, it is indeed an ear infection.

 

What are the operative indications?

Not all exostoses are surgical. On the other hand, recourse to an operation should be considered in the event of:

Very frequent otitis externa or obstruction of repeated AEDs

Obliterating exostosis (completely or almost completely obstructing) the AED Deafness linked to obstruction of the AED

How is the intervention carried out?

The operation takes place under general anesthesia, in outpatient surgery. No skin incision is necessary, the surgical procedure going through the natural duct. The surgical principle consists of taking off the skin while preserving it and removing the supernumerary bone. The exostoses will be gradually and delicately removed in small shavings using small osteotomes adapted to the size of the ear. This so-called “cold” technique (as opposed to old motorized techniques which can burn the skin and sometimes require several months of healing) allows very rapid healing of the skin covering and therefore early resumption of swimming.

What is post-operative care?

To best reapply the skin of the AED, the ORl will place a tampon in the AED. This wick will be soaked with ear drops at home by the patient morning and evening. The latter is removed on the 7th day. No home dressing is needed.

Aquatic activities can be resumed on average after 3 to 4 weeks postoperatively if technical with the osteotome.

How to avoid surfer’s ear or exostosis?

It is feared in many sports, but in surfing, the necessary characteristics are given to suffer it. Knowing how to prevent and avoid it is simple. Here we leave you some tips to avoid exostosis or surfer's ear.

Wear earplugs

You are going to think that it is a nuisance, that you do not listen well to your colleagues in the water, that you lose balance when you catch the wave, that they are uncomfortable ... That was true a few years ago. But everything has changed.

Just as computers have arrived, the mobile phone, the internet, and countless other technologies have come into our lives, it also applies to the world of surfing. Earplugs used to be a rubbery mass, uncomfortable, that did not adapt well, that did not allow you to listen and that you lost all the time to the minimum roll. That has changed! Now the earplugs come in sizes, you have different models to choose from and with different finishes and materials. Today there are multiple options to protect your ears while you are in the water without losing hearing quality.

Today almost all earplugs come with a respirator so that the air can breathe easily without water getting into the ear. If they fit properly, you don't have to fear that they will fall off in a wipe-out. If you are very paranoid about losing them, you have them with an ' invention ' to be able to hook them to the suit and that they do not stay at the bottom of the sea.

The best recommended earplugs

The best earplug on the market are the one designed by surfer for surfer! Check our collection and find the best earplugs! 

Protect the whole head

If your usual peak is extremely cold and/or there is usually wind, another option is a neoprene hat. Not only will you prevent your brain from going crazy with the first duck, but you will also keep your ears protected and your ears warm, what as our wise grandmothers say, that way all the cold of the body is lost.

If you regularly surf in cold weather, the hat is highly recommended.

The ideal is to take advantage of everything that a neoprene cap can offer you and go to the most comprehensive one, the one that covers your entire head and protects your neck. If just thinking about it overwhelms you, you have much more comfortable options.

Take care when you get out of the water

It is true that good protection helps, but it has to be accompanied by a routine of care that keeps us healthy.

Many surfers have a bad habit of using a cotton swab to clean their ears when they get home. IT'S A TOTAL ERROR. And your GP will tell you the same. The ear swab does not clean, it introduces the remains of saltpeter and sand even further into our ear canal, increasing the obstruction.

We recommend doing gentle rinses with lukewarm water while you shower after bathing. In case you have to rush to work and cannot do it, it is best to ask your usual pharmacy for cleaning sprays. These will make the saltpeter out of the ear, without causing the dreaded calcification of the auditory bones.

When in doubt, consult a specialist

And it is that we are specialists in surfing. We can advise you on materials or practices that we carry out from experience. But if you suspect that you suffer from a surfer's ear or want more advice on how to heal yourself, the best thing you can do is go to your ENT doctor. He will really have found cases like yours and can help you keep your hearing healthy.

Exostosis, or surfer's ear, is not an injury to be taken lightly. It can reduce your quality of life and keep you out of the water forever. Our advice is only to prevent it, not to cure it. If you think you have this disease, visit a doctor. Surfer's ear is a calcification of the auditory bones. Exposure to prolonged adverse conditions can take you to the operating room, reaching a point where it is irreversible.

Treatment and Surgery

For mild cases, the treatment is usually ear cleaning that should be done periodically in addition to using boric alcohol blotting drops in the ears to dry the ear canal after exposure to water or cold. (Consult previously with the pediatrician and ENT)

It is important to thoroughly dry the pinna and the accessible area of the canal with the tip of a clean cloth. In the case of being in contact with water, it is essential to use earplugs and a swimming cap for greater control.

In more serious cases, the treatment to follow is surgery. There are two types of surgical interventions to remove the bone: One of the methods consists of making a small incision behind the ear and removing the bone growth using a surgical bur, while the second method consists of extracting the bone by inserting the surgical bur directly. inside the ear canal.

After surgery, the patient should avoid contact with cold water or wind for a period of 2 to 6 weeks, as indicated. In the case of children, it is important to avoid putting dirty fingers in their ears and avoiding contact with other factors that may affect their recovery.

If you continue in contact with these extreme conditions without protecting the ear canal after treatment, bone malformations can develop again and, thus, suffer from this condition again, among others of greater importance. Performance of the intervention

The operation is performed under general anesthesia. A preoperative anesthesia consultation is essential. It is the competence of the anesthetist-resuscitator, whom you will see in consultation prior to the intervention, to answer your questions relating to his specialty. Local anesthesia will most often be performed in addition, using xylocaine.

The intervention takes place, as a rule, through the external auditory canal. If necessary, an external approach can be performed, leaving a small scar in front or behind the ear.

After detachment of the skin, we proceed to the instrumental ablation of this exostosis or bone growth. Depending on the extent of the excision and the quality of the skin of the external auditory canal, a skin graft may be necessary.

The length of hospitalization and post-operative care will be specified by your surgeon.

What is the assessment before surgery?

The consultation at the ORl will take stock of the state of AEMs. The degree of obstruction can be evaluated under a microscope and visible to the patient on a screen connected to it. A recording is also possible, making it possible to monitor the evolution of the pathology from one year to the next. Cleaning of the EAW will often be carried out at this stage. It is advisable to perform an ear scan before any surgery. This painless examination informs the surgeon about the position of the osteomas, the position of the facial nerve which crosses the ear bone, and the existence of any associated pathologies of the ear. A preoperative audiogram is essential. It provides information on the existence of deafness associated with or caused by exostosis.