Its hard to imagine that the “sound of outer ocean on a beach” could slowly be lost due to a sport. But it is a sense that surfers may start to notice over time that they are losing. And this is even stranger when it is noted that this is due to growths occurring in the ears of surfers. But on the Gold Coast this alien ear pathology is a common presentation which is easily avoidable.
Around 65% of surfers have evidence of a condition called Surfers Ear and it is found less often in amateurs than professional surfers. There is a strong connection between years of surfing plus experience of surfing and the chances of developing surfers ear. So why is this so important? In fact, certain cancers can present with similar symptoms to surfers ear making assessment and diagnosis of this condition very important.
The ear is divided into three parts – external, middle and inner ear. The external ear is made up of the cartilaginous plates of the top of your ear and the entrance to the ear known as the external auditory meatus. Sound is collected in the external ear and conducted to the tympanic membrane or ear drum which marks the start of the middle ear. The middle ear contains tiny bones necessary for proper hearing. The middle ear is also connected to the nasal cavity via the auditory tube which helps with equalising pressure between the outside and the middle ear. Finally, the inner ear is the last stage in detecting hearing. Its other job is involved in balance. I’m sure with winter coming up there will be an upcoming article on otitis media in three year olds but the focus of surfers ear is the external auditory meatus, so I will focus on that today.
Surfers ear presents as bony growths that appear in the external auditory meatus and are called exostoses. The interesting part about this condition is that the mechanism causing the growth of these lesions is not fully understood. It is thought to be due to prolonged and repeated exposure to cold water – although the exact temperature range that puts someone at risk has not yet been identified. This cold water exposure is thought to cause inflammation of the underlying bone leading to new bone formation. It has even been seen in Victorian Surfers who predominantly get lumps in their right ear which has been put down to the fact that while looking for the next wave their right ear is facing the winds that dominate Victorian beaches. This leads to lumps in the ear canal. As they get bigger they can block the canal, cause ongoing problems with infection, ringing, itching, hearing loss and a feeling of fullness in the ear canal. These exostosis also lead to further complications as it impacts the normal self cleaning mechanisms of the ear. As such debris, water and wax get stuck in the external canal as they are unable to cleared.
Treatment depends on the extent of the problem. Small exostoses can be monitored with regular ear washing out. This is done by your gp through either suctioning the ear or ear syringing. The main aim of which is to avoid complications of the condition. Surgical removal may be useful in some cases but can be difficult depending on the size and number of exostosis present. In addition there are a number of important structures close near by the external auditory canal, so as with any surgery, surgery for surfers ear is not without its risks. Unfortunately, even after surgery if cold water exposure continues these lesions can recur.
As with a lot of conditions, prevention is always better than cure. Surfers need to consider their ears if they continue to surf in cool conditions. A study of UK surfers showed that 60% of surfers knew of water precautions required to avoid development of external auditory canal exostoses. Despite this only 2% then always used these precautions and only half used them “sometimes”. It is generally accepted that the use of head protection or ear plugs will protect the ears although no studies have been performed to prove this. But if prevention hasn’t worked then even small exostoses need to be carefully assessed and diagnosed appropriately to exclude a more sinister cause for the symptoms. Once properly diagnosed surfers ear can often monitored for progression and and managed with regular ear toilet in order to reduce risk of complications.
- GPearls on the GC
- if you get Surfers ear in only one ear you are gazing out to sea too much
- Ear Plugs may help Surfers Ear
- Regular ear toilet will stop Surfers ears backing up