Chisel it like Hetzler

When I started the Know-Your-Ears Project in Mexico I did not know about Dr. Hetzler. Not for long. Surfers kept telling me about this doctor from Santa Cruz, THE doctor for Surfer’s Ear surgery. Many didn’t remember the name but every surfer from California had heard about this guy who uses a chisel to get rid of the bone growth in the ear canal. Eventually, somebody knew his name. Of course, I wanted to get in touch with him as soon as I was in the USA a couple of months later. And it worked out. I was lucky enough that Dr. Hetzler shared his work with me.

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Dr. Hetzler in action

Like most other ENT surgeons Douglas Hetzler used to perform Surfer’s Ear surgery with a drilling device for several years. Even though his results were good, he was not happy with the technique. His main concern was the acoustical trauma caused by the drilling (over 120 dB) which gave some surfers tinnitus or even hearing loss after the operation. A conversation with Dr. Robert Scott, the founder of Doc’s proplugs who has been involved in research on Surfer’s Ear for many years, let Dr. Hetzler reconsider. It is known that the bone was growing in layers. This seemed to be favorable for using a chisel. Dr. Hetzler tried a new technique and realized that the chisel was working really well to get rid of the bone growth. Soon the drill became unnecessary in most of his operations. Working together with surgical gear suppliers he enhanced his tools and found out that besides avoiding the acoustical trauma the chisel caused less tissue damage. After surgery the ear canal would heal way faster. When using a drill for Surfer’s Ear surgery the area the surgeon is working on gets hot. So even if the surgeon does not touch the facial nerve the thermal trauma of the drill can lead to nerve damage. Damaging the facial nerve is the most severe side effect of Surfer’s Ear surgery. So the chisel is a great way to lower the risk.

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Chiseling all these little pieces of bone out of a tight bleeding ear canal requires time, patience and some good finger coordination

After having performed surgery with the chisel on 1850 surfers’ ears Dr. Hetzler can show off great results. No facial nerve damage, quick recovery so the surfers can get back into the water after about 3 weeks in average. Also, he was able to operate even the most severe bone growth through the ear canal and did not have to use a approach from behind the ear which would be more invasive. Dr. Hetzler has documented and published his work to get the knowled spread in the scientific community. Now several doctors in California, Australia, France, Japan, and the UK have implemented the chisel technique.

This certainly does not mean the chisel is the only way. If your surgeon is used to operating with a drill there is no point in convincing him to start with a chisel on you. The drill has certain advantages especially when the exostosis touches the ear drum.
A few decades ago the chisel used to be the only way to operate the bone around the ear and ENT surgeons used to chisel around for hours every day. Then, the drill took over – for a reason. The safety of many operations was improved, the time of surgery was cut in half or less and some complicated operations like Cochlea implantations were only made possible by drilling. So the drill is not bad but in many cases of Surfer’s Ear the chisel is better as long as the surgeon knows how to use it.

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Group picture the day of my visit

If you are about to undergo surgery make sure you talk to your surgeon about the technique he is going to apply. Is it really a good idea to go to Thailand to save money? Probably not. In landlocked areas or warm water destinations you could be the first Surfer’s Ear patient for an ENT surgeon. It will pay off to see somebody who is experienced with this particular operation.

Dr. Hetzler has patients from all over the USA and a whole bunch of international patients as well. His anecdotes are really entertaining and he is happy to share his knowledge and experience with ENT surgeons around the world. After learning from him as part of the Know-Your-Ears Project I am meeting ENT surgeons everywhere I travel to share the knowledge and to learn more myself. So far the feedback has been great.

For more information see:

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

Dr. Hetzler online: http://www.pamf.org/dr-douglas-hetzler.html

 

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