This is me, absolutely off my head, immediately after I had surgery on my ear. It was the culmination of an 18-month history of recurrent ear infections and I hoped it would be the end of that chapter. As it turns out, it wasn’t.
Surfer’s Ear is a condition affecting the bones of the ear canal or external auditory meatus. It is caused by regular exposure of the ear to cold conditions, most commonly cold-water immersion while partaking in sports like surfing, swimming or, indeed, freestyle kayaking. Cold water stimulates the bone to grow and change shape, creating protrusions of bone (bony exostosis) that narrow the ear canal. Why is this a problem? Well, in mild cases, a bit of bony exostosis is nothing to write home about. The patient remains largely asymptomatic and the ear continues to function normally. However, without taking preventative action, this exostosis will continue to enlarge. Ultimately, this can create a ‘bottleneck’ situation in the ear canal, that commonly presents as the patient reporting an inability to clear water from their ear after a shower or a kayaking session.
The sensation of having water stuck in your ear all the time is annoying enough in itself but the story doesn’t end here. Bacteria and fungi love warm, moist environments. So, a chronically wet ear canal is the perfect breeding ground for microbes. Give it enough time, and you’ll develop an infection.
When you are told you have an ear infection, most commonly it means you have a case of otitis externa. This means that the skin inside your ear canal is inflamed. When your doctor has a look with her otoscope, she’ll notice the skin is red, swollen and there may be suppuration (pus). As a patient you might experience this as tenderness, loss of hearing and tinnitus (a constant high-pitched ringing in your ear). As uncomfortable as this may be, it can get worse and potentially lead to serious complications.
In my case, I ended up in A&E with fairly benign symptoms typical of otitis externa. By then, I had already been prescribed a number of courses of antibiotic ear drops over the preceding weeks - none of which had been successful. There was a growing concern that, despite the lack of more serious signs or symptoms, I had developed a middle ear infection (otitis media). Otitis media can be a complication of otitis externa if the infection manages to burst your ear drum. My ear had become so swollen, that when the consultant looked inside, she could no longer see the ear drum and verify that it was intact. The upshot of all this was that I was admitted to the hospital as an inpatient, kept overnight and had a CT of my head!
Thankfully, I did not have a middle ear infection! It did, however, take another 3 weeks to get what was a severe case of otitis externa to resolve. During this time, I had a dressing the length of a shoelace packed deep inside my ear. I was deaf as a post and wasn’t able to kayak until it was removed and the infection had resolved. Needless to say, I never wanted to experience that again. So, I decided to get the surgery to correct the problem for good.
The surgical treatment for Surfer’s Ear is called a canaloplasty. Essentially, the aim is to remove the bony exostosis. In doing this, it re-establishes the normal anatomy of the ear canal, reduces the risk of water stagnation and, accordingly, reduces the risk of infections. Sounds great, right? While surgery can be an excellent solution, it is not without risk. Some of the main ones to be aware of include:
There’s no guarantee the procedure will be a success. Unusual types of scarring and post-operative infection are possible complications that may compromise the outcome. Sometime it is necessary to repeat the procedure.
The structures surrounding the exostosis can be damaged. This includes the ear drum, jaw joint and facial nerve. Damage to the latter can manifest as changes in taste perception or function of the muscles of facial expression.
General Anaesthesia, while considered very safe for young healthy adults, can give rise to thromboembolic events (clots in the leg, lungs, brain etc) or even death. While rare, such complications can occur.
Long-term hearing loss, tinnitus or issues with balance.
Before you sign your name on that consent form, you’ve got to be satisfied that you understand these risks and are happy to take them to improve your condition.
My own experience of the procedure and the recovery was, as I’m sure is typical, pretty positive. When I woke up in the ward, I was fairly out of it. I’d liken the feeling to being a touch more-than-tipsy. Picture that older relative at Christmas dinner who has had a few too many wines; words notably slurred, a bit unsteady on their feet, but having a jolly good time. That’s what it was like. If I’m being honest, it was quite enjoyable. I took a lot of selfies. The days that followed weren’t so bad either. The post-operative pain was mild – easily managed with over-the-counter meds. The surgical dressing that was in place meant that I could not hear, but sure that was often the case with infections anyway. My biggest concern was that my ear was a bit lopsided! The worst of the swelling abated over the first 2 or 3 weeks, but it took a number of months for the tissue around my ear to completely settle and return to normal. I think I took a total of 8 days off work.
Of course, in the earlier stages of healing, you cannot under any circumstances get the inside of your ear wet. This means no kayaking. Even in the shower, it’s imperative it is kept completely dry. In my case, I had what is called a postauricular incision as part of my surgery. This means that, in order to gain access to the exostosis, the surgeon cuts a surgical flap behind the ear, following its curvature. It is a relatively large incision but when it is healed, it’s barely visible as it remains hidden behind the ear itself. It took 5 or 6 weeks for this to heal to the point where I could kayak again.
Notably, it is possible to reduce the recovery time if a different surgical technique is used. This involves using a smaller, more conservative incision in the tragus (a popular site for ear-piercings). While speedy recovery is great, the downside is that this technique can make orientation and access more challenging for the surgeon. Having worked as a dentist, I can absolutely appreciate how these factors can dramatically affect the difficulty of a procedure. Personally, if someone is drilling anywhere near my facial nerve, I want things to be as easy as possible for them! Either way, the appropriate surgical technique is case-dependent and the surgeon will guide you in this regard.
It has been almost two years since I had my canaloplasty and, while I occasionally still get an ear infection, they are much less frequent and generally respond promptly to medicated ear drops. As with many things, when it comes to Surfer’s Ear, prevention is definitely better than cure. Ear plugs are widely available in many forms and are a great way of protecting your ears from the cold. Many different companies manufacture them, some pre-fabricated, some custom-made. If you don’t have a set and want some (even if you don’t want some, do yourself a favour and just get some anyway), check out SurfPlugs here. They offer custom-made, silicone ear plugs and are passionate about preventing Surfer's Ear; so much so that they have generously offered to give away a set for free to the winner of a raffle over on my instagram.
Ultimately, when choosing your ear plugs, you want something that is first and foremost dry. After that, things like comfort, retention, sound penetration, ease of cleaning etc can be considered to find the best solution for you. While cost does vary, I wouldn’t let that put you off trying some of the more expensive options. This is an investment that can save you hours of your life that you would otherwise waste sitting in an A&E department waiting for a doctor to stick some pointy stuff into your already painful ear. At the end of the day, there is nothing more valuable than time.
Ironically, my experience with Surfer’s Ear has taught me to listen. I had heard the same preventative advice many times from friends, mentors, on social media and I did nothing. I just thought “Nah, I’ll be grand. My ears are sound. That won’t happen to me.” Fake news! I’ve said it before and I’ll say it again; information loses its value if it’s not actionable. So, take action. If you don’t have ear plugs, go get some. It’s so easy. You can thank me later.