Surfer's Ear: a silent abnormal condition that affects cold water surfers | Photo: SurfEars

Almost all lifelong surfers get some degree of exostosis, but the condition commonly known as "surfer's ear" will likely require surgical intervention in those who don't wear earplugs.

Surfers are always exposed to the elements. The nature of surfing puts wave riders in constant contact with water, wind, sand, and pollutants.

However, when the air and water temperatures decrease, a silent enemy threatens all surfers' health - it's called surfer's (or swimmer's) ear.

But what exactly is surfer's ear?

Surfer's ear, also known as exostosis, is a condition in which abnormal benign growths of bone form under the skin of the outer ear canal.

These bony growths, caused by repeated exposure to cold wind and water, can lead to hearing loss and other complications.

The condition affects people of all ages but is most common in water sports enthusiasts who engage in frequent and prolonged exposure to cold and wet environments, such as surfing, windsurfing, kiteboarding, kayaking, sailing, diving, and swimming.

In some cases, chronic ear infections or physical trauma can also cause exostosis.

How is Surfer's Ear Diagnosed?

As we've seen above, exostosis occurs when the ear canal is repeatedly exposed to cold and water.

Consequently, there's an increased blood flow to the ear canal, which stimulates the body to produce new bone.

Over time, these bony growths can become more prominent and block the ear canal, leading to hearing loss, pain, infection, dizziness, etc.

The diagnosis of surfer's ear is typically made through a physical examination of the ear canal.

An otolaryngologist may use an otoscope to look for bony outgrowths or use a computed tomography (CT) scan or magnetic resonance imaging (MRI) to better view the ear canal.

Surfer's Ear: a benign bone growth under the skin of outer ear canal

A Condition That Affects Surfers in Their 30s and 40s

The surfer's ear becomes more acute and severe over time, especially when sportsmen and sportswomen reach their 30s and 40s, having surfed a decade or more without ear protection.

Surfer's ear is irreversible, and only proper surgery will solve the health problem.

When ears are exposed to cold water and cold winds for a long time, our body tries to protect the auditory system from low temperatures by building a first line of defense.

In the most extreme cases, the new cartilage completely shuts off the ear canal, leading to ear infections - for example, acute otitis media (AOM) - tinnitus (ringing in the ears), and even hearing loss.

Half of the surfers with surfer's ear will only develop a mild form of exostosis, i.e., when small bony lumps block only less than one-third of the ear canal.

Then, there's the moderate surfer's ear (between 33 and 66 percent of blockage) for a quarter of riders and a severe condition for another quarter.

Someone with 75 percent (or more) of surfer's ear should consider surgery because the amount of ear closure leaves a tiny opening for air and sound to reach the eardrum.

Simultaneously, earwax and water are trapped and will block your ears even further.

What Are the Symptoms of Surfer's Ear?

The first signs of exostosis appear in surfers with five years of water sports involvement.

Wave riders who surf in water temperatures below 60 °F (15.5 °C) have 2.6 times more chances of developing severe exostoses.

Also, the worst ear is generally the one exposed to the prevailing wind.

For example, if you're surfing in California, sitting on your surfboard waiting for the waves, and the wind is blowing from the north, your right ear will be more exposed to the cold wind than your left ear.

Prevention of Exostosis

Surfer's ear is a silent abnormal condition and causes few symptoms. Initially, there's no pain and no bleeding.

But in a matter of months, you start losing hearing and feeling there's something wrong with one of your ears.

When it happens, immediately contact an otorhinolaryngologist and get a pair of silicone earplugs.

It would help if you started using them in the shower and during winter or summer surf sessions.

Finally, protect your ears with a thick wetsuit hood and high-end surf earplugs.

Remember that the colder it gets, the faster you'll develop surfer's ear.

Surgery Is the Only Treatment

There is no treatment with medicine or effective therapy against exostosis. The only solution is the operating room.

If your doctor advises you to undergo ear surgery, don't think twice - go for it. 

The surgeon will remove the obstructing bone by drilling the unwanted lumps under general anesthesia, restoring your hearing.

The procedure may involve drilling out the growths or placing a tube in the ear canal to allow drainage.

The healing process keeps water sports participants out of the water for between four weeks and three months.

Your doctor might prescribe anti-inflammatory medications and ear drops to reduce inflammation and pain before surgery.

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