Surfer’s Ear: Operation Techniques and Complications

Sometimes there is no way around the surgery. The bone in the ear canal has grown over many years and there is no way of making it grow back. As soon as your quality of life is severely impaired because your ear is troubling you it is time to see an ENT specialist. Symptoms can vary between recurrent ear infections, hearing loss, tinnitus, and even vertigo symptoms have been reported. This post will give a detailed overview over the current surgery techniques that are being used to get rid of Surfer’s Ear. This might be too much information for some of you. It is ok to stop reading here. With the right surgeon it is a low risk operation. Just keep in mind: This operation should be done by a specialist who has performed the procedure many times before. The further away from the ocean you go the less likely it gets to find the right ENT doctor for this kind of sugery.

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Surfer’s Ear is not a common operation everywhere. So unless you want to rely on the orange guy in the back make sure your surgeon performs the operation regularly.

If you are interested in medicine, keep reading. Here are some details.

There are several ways to operate Surfer’s Ear. The idea is simple: the bone that has grown into the ear canal has to be removed. The art of doing so is not as simple. The operation can be performed through the ear canal (trascanal approach), through an incision in the ear (endaural approach), or through an incision behind the ear (postauricular approach).

And there are several instruments that can be used. To have a good vision the surgeon usually uses a microscope but good results have been reported with an endoscope as well (1). The most commonly used technique is removal with a drilling device.  This allows the surgeon to have good control. It has the disadvantage of heating up the tissue in the ear region. This is why some surgeons have gone back to use a chisel (or osteotom in medical English) and recent literature suggests that this has some advantages for the patients (2,3). A post about this technique will follow soon.

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Diamond burr used for drilling

Some surgeons say they use a laser which from my understanding does not make sense. I did not find any scientific articles that suggest a benefit of a laser and I have not talked to any surgeon who uses that technique. As soon as I do I will update this post.

The Facial Nerve
Besides slow healing of the inevitable tissue damage the most severe side effect of the operation can be a damaged facial nerve. Don’t panic. The odds are really low, far less than one percent. I would love to give trustworthy numbers but the only quality study I found was on general ear surgery. Of 22 operated patients with a damaged facial nerve in the famous House Ear Institut in Los Angeles suprisingly three were surfers operated because of exostosis (4). They perform several hundred ear operations each year so no reason to panic but it should be mentioned. The facial nerve makes its way through the temporal bone not far away from the posterior wall of the ear canal, the exact position varies (5). By operating in this area it can be damaged mechanically or through the heat of the drill even if the surgeon does not touch it. A damaged facial nerve will disable most muscles on the operated side of the face. Besides negative aesthetic effects which some scar hunting surfers might consider minor, it severely affects social interaction. Other side effects are acoustic traumas caused by the sound of the drill that can lead to hearing loss and tinnitus (6), a damaged ear drum or wound infections that can keep you out of the water for months.

How long you will have to stay out of the water depends. The retroauricular approach with the drill will take about 6 weeks on average, the transcanal approach with a chisel will take about three and a half weeks on average to full recovery (2,6).

Literature

This list is not about quantity but about quality. If you work in the field these articles are worth reading:

1 Kozin, Elliott D., et al. “Endoscopic transcanal removal of symptomatic external auditory canal exostoses.” American journal of otolaryngology 36.2 (2015): 283-286.

2 Hetzler, Douglas G. “Osteotome technique for removal of symptomatic ear canal exostoses.” The Laryngoscope 117.S113 (2007): 1-E4.

3 Ghavami, Yaser, et al. “Transcanal Micro-Osteotome Only Technique for Excision of Exostoses.” Otology & Neurotology 37.2 (2016): 185-189.

4 Green, J. Douglas, Clough Shelton, and Derald E. Brackmann. “Iatrogenic facial nerve injury during otologic surgery.” The Laryngoscope 104.8 (1994): 922-926.

5 Adad, Basil, Barry M. Rasgon, and Lynn Ackerson. “Relationship of the facial nerve to the tympanic annulus: a direct anatomic examination.” The Laryngoscope 109.8 (1999): 1189-1192.

6 Frese, K. A., H. Rudert, and S. Maune. “[Surgical treatment of auditory canal exostoses].” Laryngo-rhino-otologie 78.10 (1999): 538-543.

 

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One thought on “Surfer’s Ear: Operation Techniques and Complications

  1. Hi I had surgery 6 months ago. From this I have constant tinnitus, probably 80% hearing loss in that ear , fullness and a really awful hearing in operated ear. I need a plug in it in noisy situations as it makes sound confusing. I wish I had not had the surgery.

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