by Stuart Gooding.
Lets face it, as surfers we’re under constant assault from the elements. When we’re not duck diving in the freezing depths of winter, we’re cutting our hands and feet on the reef (or less exotic – the car park), getting burnt by the sun and our skin dried from the relentless wind. Perhaps we should salute this devotion to our craft as loved ones look on in horror as our noses intermittently drip and drain salt water at the most inappropriate time. Often, spontaneously in front of our coworkers giving the game away of an early morning surf and why you’re so tired, dishevelled and it’s only 11am. For most of us this is part of the fun, but what about our ears?
Ok, now we’re in familiar territory and we know what we’re getting at – “Surfers Ear”. This is the surfer’s malady. It’s been written about before, sure, we might even have winced over those scary surgical photos in the surf mags a few times over the years or read about the horror stories – but winter’s here and as water temperatures plummet in the Northern hemisphere, there’s no harm in reminding ourselves why we need to look after those radars that sit on the side of our heads.
There’s a few medical problems named after sports people. Lateral epicondylitis – “tennis elbow” comes to mind and obviously the dreaded “athlete’s foot” is a problem to some. “Surfer’s ear” or “exostosis of the external auditory canal” is one of these sporting ailments. It’s not just surfers, but also sea swimmers, scuba divers, kayakers and anyone else who repeatedly immerses themselves in cold water and wind who can take some credit – yet surfers, generally have the monopoly on this one, so something we ought to take seriously.
Functionally, ears are pretty amazing when you stop to think about it. They’re responsible for 1. hearing and 2. our balance. Arguably balance is pretty useful to us, but day to day, in the office, on a night out, with loved ones or having the ability to selectively tune out to hearing to your friend tell you about their year-long round the world surf trip – hearing is pretty much right up there too. Before we get into the specifics of Surfers Ear, let’s quickly discuss ear anatomy and I’ll keep it brief.
There’s three parts to the ear; the external ear which is the big fleshy part that you can move around and the ear canal that joins to this – this is the area we’re concerned with. There’s also the “middle ear” – the bit between the eardrum and the inner ear. The external ear focuses sound like a satellite dish, meanwhile the middle ear contains three tiny bones which vibrate and the inner ear transforms this energy into signals for our brain to process. The inner ear also deals with balance.
Surfer’s Ear occurs when “exostosis” restrict the ear canal. These small bony growths are not harmful in themselves, but protrude and grow very slowly due to cold water and wind exposure1. It’s likely that most surfers who immerse themselves regularly in cold water have some amount of exostosis, and this might be picked up incidentally if we were to have an ear examination. Thankfully, for many, these small bony growths don’t cause too much of a problem. These grows tend to appear after perhaps half a decade of serious surfing, but no one is really sure what factors influence how quickly they develop. Likewise, there are theories, but no clear reason as to why cold water & wind in particular stimulates the growth, yet they are a near universally reported finding in the medical literature amongst regular cold water surfers and serious ocean users. Thankfully for us, there’s a small group of researchers (perhaps surfers who wanted to get out of the office) who have worked all of this out for us – often by hanging out at surf comps and offering an ear examination, with studies taking place in the parts of the US, Japan and the UK2,3,4.
For a significant amount of surfers, the bony growths may be bigger and begin to block the external ear canal itself. Occlusion of the canal itself can to what is termed a “conductive” hearing loss, and a buildup of wax and debris that gets stuck is often a contributor to this5. The ear might begin to feel full, as if water won’t clear after you’ve been in the water. Blockage can lead to water being trapped which increases the likelihood of an external ear infection (Otitis Externa or “swimmer’s ear”) as sea water and associated debris tends to get stuck behind these growths in our nicely warm ears – providing the perfect petri-dish environment for nasty bacteria to grow in. Some surfers suffer from repeated ear infections that leaves their ear inflamed, swollen, sometimes oozing as the body’s basic inflammatory defences kicks in. Ear infections often lead to significant pain, loss of hearing, and keep us out of the water. Rarely other complications can develop if the infection spreads to other areas of your head or face. So, whilst these bony growths are pretty harmless in themselves, they do cause ongoing problems for some surfers.
What’s to be done? As avid surfers with our own ear pathology, what can we do to prevent this from keeping us out of the water and do what we love? As usual ear plugs & hoods are the mainstay in terms of reducing the effect of cold water on our ear and keeping the elements at bay6 – although it’s not a perfect solution and I’m not sure if one exists. There’s a variety of products on the market that are designed to protect your ears when you surf, and some ear plugs can be specially moulded to your ear and allow you to hear whilst in the sea, which for me is a deal breaker, and one reason why I have avoided ear plugs in the past. Other ear plugs are the more basic putty types. It’s worth shopping around and seeing what suits your needs.
If you’re concerned about your ears; you’ve got a nasty ear infection at the moment, you’re getting repeated ear infections, or experiencing any pain, hearing loss or tinnitus, the key recommendation by the experts is to make sure you book an appointment with your GP. Your doctor will be able to take a look inside your ear canal with a simple scope. Doctors who are based in surfing areas are often fairly knowledgeable about the condition, others may be less familiar. Ear nose and throat (ENT) specialists based around surfing areas are used to seeing surfers in their clinics and if you have a problem that may require further specialist input, then your GP may well refer you to see one of these doctors at the hospital.
Surgery (removing the bony growths with a tiny drill or chisel) is sometimes used to remove the small bony outgrowths if they are providing ongoing problems, but many surfers will not need this and simple preventative and precautionary measures will be more useful to prevent further obstruction of the ear canal. If surgery is needed it’s usually as a day case but it’s likely to keep you out of the water for long enough that your probably need to avoid your surfer friends and try to re-integrate into landlocked society whilst your ear heals and to avoid further infection.
I have avoided using ear plugs most of the time but I tend to wear a hood religiously through the winter, yet increasingly each winter I tend to get an ear infection and my sense of hearing definitely feels worse than it should be. Like many things related to our health that are good for us but take a bit of effort, we’re often guilty of avoiding them. This is one of those things that creeps up on people so slowly, we often fail to take preventative action. Me included. In fact, I would hasten to bet that a fair few of us spend more time fixing dings than thinking about looking after our ears. A trip to the ear doctor for me then. Ear plugs, well, they’re on order.
The bottom line, protect your ears whilst you can and if you need advice on the state of your ear’s, see your GP. Surfer’s ear – it could ruin that next good swell, or at worse, your favourite pastime.
References and further reading:
- Kroon DF, Lawson ML, Derkay CS, Hoffmann K, McCook J. Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngology–Head and Neck Surgery. 2002 May 1;126(5):499-504.
- Attlmayr B, Smith IM. Prevalence of ‘surfer’s ear’ in Cornish surfers. The Journal of Laryngology & Otology. 2015 May 1;129(05):440-4.
- Deleyiannis FW, Cockcroft BD, Pinczower EF. Exostoses of the external auditory canal in Oregon surfers. American journal of otolaryngology. 1996 Sep 1;17(5):303-7.
- Umeda Y, Nakajima M, Yoshioka H. Surfer’s ear in Japan. The Laryngoscope. 1989 Jun 1;99(6):639-41.
- Rensink MJ. THROUGH THE OTOSCOPE: The pearls of surfer’s ear. The Hearing Journal. 2011 Nov 1;64(11):8.
- Reddy, V. M., Abdelrahman, T., Lau, A., & Flanagan, P. M. (2011). Surfers’ awareness of the preventability of ‘surfer’s ear’ and use of water precautions. The Journal of Laryngology & Otology, 125(06), 551-553.
Disclaimer: This article is for general information only not specific medical advice, if you’re concerned about your health, ensure you seek medical advice from an appropriate professional.
Stuart Gooding is a surfer and Medical post-grad currently based in Wales.
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