Unlike “swimmers ear” or otitis externa, “surfers ear” also called exostosis is a buildup of abnormal bony growth in the form of lumps inside the ear canal.
Because surfers ear causes bony growth to build up in the ear canal, it starts to block the ear canal, making the passageway smaller. This can lead to difficulty hearing, and an increase of ear infections and swimmers ear.
Surfers Ear is caused by our ears having repeated contact with cold water and wind. It is more common in the surfing world – hence the name, but divers that repeatedly dive in cold water can also suffer from this condition.
In surfers it is generally more prevalent on one side (the side facing the prevailing winds when surfing), however with divers it generally occurs on both sides together due to the fact that both ears are in the cold water together.
Surfers ear is a progressive condition, meaning that it will start off slowly and become progressively worse over time with repeated exposure. This is why cold water divers must take preventative measures early on.
“But I only dive in warm tropical waters, I can’t possibly get surfers ear can I?” Even though the temperature of the water is warm, when you surface from the water into the “trade winds” that continually blow across the islands the water in the ear canal evaporates, causing a cooling effect inside the ear canal which could lead to surfers ear.
There are a couple of simple things that a diver can do to avoid getting surfers ear:
- Wear Vented Ear Plugs – I know you remember back in your Open Water Diver training that divers should never wear ear plugs because it prevents them from being able to equalize their ears. Vented Ear Plugs on the other hand prevent water from entering the ear canal but have a tiny hole in them to allow air equalization through them, but the hole is too small for water to pass through.
- Wear a Wetsuit Hood – Wetsuit hoods will keep our ear canals nice and warm, and prevent them from being chilled by evaporation from the wind.
- Wear a Stocking Cap or Beanie – After diving put a stocking cap or beanie on to cover the ears. This will keep you warm while preventing the wind from evaporating the water in your ear canals and cooling them too quickly.
“How can I tell if I already have surfers ear?” There are a few simple things to look for like:
- Take notice of any pain, popping or crackling that originates in your ear.
- Tilt your ear toward the ground and shake your head to see if you can hear water trapped in your inner ear.
- Ask yourself if people are always telling you to turn down the music or the TV, or if they tell you that you talk loudly.
- Think about whether you’re asking others to speak up, even when they are sitting right next to you.
- Visit a doctor, preferably an ear specialist, and get a second opinion to verify any diagnosis.
If the condition is left untreated and becomes severe enough surgery may be necessary to alleviate it by drilling and cutting away the abnormal bony growth. This used to be done by making an incision behind the ear as well as going in with a drill through the ear canal.
There is a new process now where they will use chisels to remove the abnormal bony growth through the ear canal instead of making the traditional incision behind the ear. This new process also eliminates most of the use of the drill as well. The new process submits the patient to less noise during surgery that could damage hearing, and speeds healing afterwards.
By utilizing these simple steps outlines above, you can help prevent surfers ear from starting in the first place and the need for painful surgery.
Otitis externa or “Swimmers Ear” as it is commonly referred to is a very common ailment affecting swimmers, divers, surfers, and anyone else who spends a lot of time in water. Otitis externa is the fancy technical term for an external ear infection.
Contrary to popular belief and information posted on many diving websites and forums, bacteria in the water does not cause otitis externa. It is actually caused by bacteria that is already present and lurking inside our ear canals, waiting for an opportunity to strike.
Ear wax is created by sweat glands that have been modified to produce the waxy substance that is present inside our ear canals. This necessary wax acts as a waterproofing layer that coats the canal and prevents water and bacteria from getting into the cells of the canal lining.
When the cells become saturated from frequent immersion in water they swell and pull apart just enough to allow bacteria to slip between them and find a warm moist place to grow and multiply underneath the surface of the skin. Once the bacteria is allowed to multiply and affect surrounding tissues the resulting pain begins to be noticed.
One easy way to determine where the ear is infected is by gently tugging backwards on the pinna, which is shown in the above photo. You can also gently press on the fleshy lump just in front of the ear canal which is called the tragus, If this hurts, it is an outer ear infection, if not it is a middle or inner ear infection.
If left untreated, the swelling can spread to the nearby lymph nodes and cause enough pain that moving your jaw becomes uncomfortable. At this point, the only treatment is antibiotics, either with pills, and/or ear drops, and diving is definitely out of the question until the infection has cleared up. If the infection becomes extreme, an antibiotic injection may be necessary.
It is very easy to prevent otitis externa or swimmers ear, and it will not break the bank to do it, but the following steps need to be done precisely to be effective.
Create a solution of 50% distilled white wine vinegar and 50% isopropyl alcohol, both of which can be obtained from just about any grocery store. The white wine vinegar is approximately 4-6% acetic acid, and has a pH of 3.0, which is perfect to use as a bactericidal to prevent the bacteria from multiplying. The isopropyl alcohol acts as a drying agent to draw excess water out of the cells lining the ear canal.
To administer, lay on one side and drop enough of the mixture into the ear canal to fill the canal. The most important part of the treatment is to remain still and hold the solution in the ear canal for a full five minutes. After the solution has been in contact with the ear canal for a full five minutes, turn over to allow the solution to drain and repeat with the other ear canal.
If the solution does not stay in contact with the ear canal for a full five minutes, it’s effectiveness is greatly reduced. This procedure should be done twice daily, once before the first dive of the day, and then once more after the final dive of the day.
If there is a chance of a ruptured eardrum due to a squeeze, DO NOT place drops into the ear. Doing so may inadvertently flush bacteria into the middle ear causing a worse infection problem.
If the above steps are followed exactly as described, this will prevent you from having to miss a dive because of swimmers ear.
Unfortunately I received some bad news today. On Thursday’s dive I noticed that I was having trouble equalizing my left ear and I had to force it a little bit. Apparently I forced it a bit too much, at the time I heard a popping sound but did not think too much about it because my hearing did not change and there was no immediate pain in it. That all changed on Friday though.
When I woke up on Friday I noticed pain in my left ear and my ear was plugged up so that I could hear my heartbeat. Actually hearing my heartbeat is a good thing, that is a good sign that the membrane, or ear drum, was still intact. I stayed home on Friday with a low-grade fever and took ibuprofen for the pain, hoping it would go away.
Today I woke up with the pain even worse, so I went to the hospital to have my ear checked. Even though I know what to look for and have an otoscope here in my emergency kit to see into the ear canal, I can not see into my own ears, so I was forced to rely on someone else’s opinion.
The Emergency Room physician referred me to a specialist because he thought he saw a small hole in the membrane, but he was not sure. The membrane was severely infected along with the ear canal, but he was not sure if the membrane was intact or not. So, for the next few hours I waited to get squeezed into see the specialist, worrying that I may have done permanent damage to the membrane, which could prevent me from diving in the future.
Once I was finally able to be seen by the specialist she examined my ears, noting the infections to both the canal and the membrane. She noticed what the E.R. physician had seen on the membrane but stated that she did not believe it had ruptured. It was basically like a stretch mark which was a sign of over stretching of the membrane when I forced my ears to equalize on Thursday.
Because the infection was both on the inside and on the outside, affecting both the ear canal and membrane, and middle ear she prescribed antibiotics and antibiotic ear drops for the next 15 days and benched me from diving for at least a week. If the infection has completely cleared I can resume diving after June 3rd, but if it has not completely cleared I have to wait another full week before I am cleared to dive again.
I was supposed to be assisting Michelle with another Open Water Diver class today and tomorrow for their open water dives up at Sharks Cove on the North Shore. I had to sit today out dealing with the hospital and doctors, but I will assist her tomorrow morning. I wont be able to dive tomorrow, but at least I can help out with ground support.
This not being able to get in the water for at least a week is really going to get to me. This is going to be a very long week for me. The moral of this story, if you ever have trouble equalizing your ears, DO NOT force it, not even a little bit. You may not be as lucky as I was by only having to stay out of the water for a week.