Wear Ear Plugs and a Hood

Thursday, March 18, 2010
A special message from friend of Surfy Surfy, Kevin

From now on I am wearing a hood all winter long. I've already been religious about wearing ear plugs, but that might not be enough to stop surfer's ear progression.

Ear Canal with Surfer's Ear. Image: Norwest ENT Medical Group.

I had surgery on Monday to have my surfer's ear (a.k.a. bony exostosis of the external auditory canal) removed. I opted for removal via mallet and chisel.

Here are pieces of my skull they removed.

Micro-chisel Technique is Crazy

About 5 years ago when my right ear was about 90% closed I started looking for a surgeon in San Diego. I ended up talking on the phone with three who all used the cut behind your ear (i.e. post-auricular route) and drive a high speed drill downtown technique for surfer's ear surgery. They all thought it was totally nuts to use a chisel and to go straight through the ear canal. Dangerous and archaic was their response to the idea.

At that time there weren't many papers on the technique for surfer's ear surgery. A 1997 paper by Samuel Whitaker from UCI described a method of cutting a flap of skin away from the bony growth and then hitting the growth with a microchisel to carve off the exostosis from the canal wall.

Whitaker was old school. He is a bit older than many of the other surgeons that were around and his dad was a surgeon long before high speed drills, so he looked at a lot of things differently. He looked at the problem and figured the old school tool might be a good tool for the job. I got the impression that a lot of doctors dismissed his approach at first (or just thought it was koo koo). Think about it, it does sound pretty sketchy. I liked the idea!

It was troubling that when I called UCI around 2005, when I was first looking for a surgeon, they said their surgeons were using the drill technique, not the chisel (Whitaker was in private practice in Los Angeles at that time, not a UCI).

At the same time I found a surgeon named Dr. Reisman in Oceanside who let me believe that he would use the chisel on me, so I was good to go with him. He was highly recommended by many of my friends and I scheduled the surgery. At the pre-op appointment he was very clear that he would use the drill and not the chisel, so I bailed out on that because the story changed from my initial visit to the pre-op. Didn't feel comfortable with that scenario because if I hadn't specifically asked I would have never known how he did the surgery... because I would have been under general anesthesia when the drill started spinning.

That ordeal led me to track down Whitaker in Los Angeles. Whitaker evaluated my ear and made it very clear that he thought I could go years more before surgery, especially because I wasn't having chronic ear problems and you could still see things in the ear that the surgeon would want to see when doing the surfer's ear operation.

Craziness Spreads
Fast forward to today. Surgeons at UCSD still think the chisel is more dangerous than the drill. The UCSD surgeons believe there is more control with the drill and a better sense of position by cutting behind the ear. Dr. Jack Pulec, a highly respected academic surgeon published a short note about exostoses removal in 2001. He wrote, "The use of a postauricular incision for the treatment of exostoses offers no advantage. In fact, it can give the surgeon a false sense of security." Chisel surgeons are saying that part of the reason the drill guys use drills is because that is the way they were trained, not because its the best tool. The controversy continues today.

Using the high speed drill comes with some drawbacks. The drill gets really hot and can produce heat damage. The drill is also very loud and is thought to have a risk of hearing damage. It is also notorious for doing lots of skin damage, making recovery time lengthy and painful. I surf with two guys who had the drill and both say they aren't doing the surgery again.

On the other hand, there is the widely spread story that Dr. Money left San Diego because he started using the chisel and chiseled too far one time. It is sketchy trying to understand how the docs can keep from going to far. Going too far on the posterior side of the auditory canal can cut your facial nerve. Dr. Money did leave town, but he is now the Director of an ENT clinic in Indian and there is no public record of disciplinary action against him.

I haven't found any satisfactory data that does a good job at comparing the risks of the two approaches. I'm sure with either approach the skills of the surgeon are a major factor in the risk for an individual surgery, regardless of the tools being used.

Today, lots of surgeons have adopted the chisel. Santa Cruz's Dr. Hetzler published a large case history review paper on over 200 ear surgeries that he conducted using the chisel. Hetzler has popularized the technique in the surf community. His paper was followed a year later by a similar case history paper by House and Wilkison in Los Angeles. They use the drill technique. Hearing damage because of the high speed drill wasn't a real problem in their patients.

What is interesting is that even with the controversy more surgeons are turning to the chisel.

UCI now uses the chisel. Here is video of Dr. Djalilian using the chisel for surfer's ear.


From Dr. J's website:
We use a combination of a microchisel and drill to remove the exostoses. The use of the drill is best for exostoses that are wide-based in the anterior (front) part of the ear canal and those that are close to the ear drum. Using the chisel close to the ear drum can cause a rupture of the ear drum. The front wall of the ear canal borders the jaw joint. Attempting to fracture a large exostosis in the anterior canal wall may cause the bone that surrounds the TMJ to break with devastating consequences.


I spoke to a couple surgeons who did not think damage to the anterior wall or TMJ needed to be much of a risk or issue. Dr. Hetzler's paper describes a few anterior canal walls being mobilized, but the patients remained asymptomatic. Hetzler says he's never seen a result on the anterior wall that was "devastating".

Here is video from Dr. Hetzler


Shohet Ear Associates appears to be marketing to Orange County surfers as the go to surfer's ear surgeons. Shohet uses micro-chisels, and a drill to clean things up.

I have two doctor friends, and an ENT surgeon (who doesn't do surfers ear) who have recommended San Diego's Dr. Beros for surfer's ear surgery. One of them just had Dr. Beros do his own ear and it was done with the chisel.

Local/General Anesthesia
It appears that drill surgeries take a lot longer. I had the chisel and they weren't really working on my head for more than 40 minutes. The chiseling is really a tiny fraction of that time. I know because I was awake and I remember.

Dr. Whitaker has done almost all of his surgeries under local, with sedation. He was trained to be a surgeon when the use of general anesthesia was less common for many procedures. Dr. Jack Pulec's note also mentions that he did these under local anesthesia too. I know that for some people, the worst part of the whole experience is dealing with the general anesthesia.

It is not totally nutty to do it under local. My neighbor had his ear done two weeks ago by a Kaiser doctor (Dr. Broberg) under local anesthesia too. No biggie, and you are up and productive hours after you have surgery.

Because I was awake, I am certain to remember the bang, bang, bang (not tap, tap, tap) of the chisel on my skull the next time I even think about paddling out in cold water without my earplugs and hood.
The real reason Kevin's ears closed up is because his turns go SLAAAAAAAASH so loud his ears couldn't take it anymore.

45 comments:

  1. That was very informative. Thank you for passing on your knowledge of this procedure. I am going to buy earplugs tomorrow!

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  2. Doc's Pro Plugs bro!!!!!!!

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  3. http://www.proplugs.com/

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  4. Kevin - The timing of this article couldn't be more apt. I just went and saw Dr. Virri at UCSD and he suggested that I have a pretty gnarly case of surfers ear. I'd like to get together and chat about your experience with this guy and the surgery. I'd also like to know whether or not you feel like it made a big difference in your hearing, and if you previously had any "constant feeling of water" in your inner ear, and if that's gone now.

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  5. I had both mine done using the same technique.
    Dr. Merrell in Port Orange , Fl. I was his last Pt. Retired surgeon. No issues. Nice HACK !!!!!

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  6. How about a content warning for the feint of stomach. Gross.

    Still, convincing case for using plugs. I wondered what the hell all the fuss was about.

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  7. beep beep,

    send me an email at leucadiablog@gmail.com

    kevin

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  8. I know exactly what your going through. I'm 54 years old and have had the surgery twice in each ear. 2X2=4. I dawn patrol Uppers 3-5 days a week and I always wear silicone earplugs, a 3mil hood in the winter and 1mil hood in the spring and fall. So far there is no growth and it's been 8 years. I was told by my doc that not only do you need to keep the water and wind out of your ear canal but the whole area around your ear should be kept warm which means the F'n hood. He's not a fan of pro-plugs because they let water in, he prefers that I seal the ear with silicone.

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  9. the best part about the chisel is you can make a very surfy necklace for your girl friend!

    I did not get cool swag with the drill

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  10. Hey, great, informative post. I had the surgery with the drill. It was a gnarly, bloody affair. But I gotta say, the chisel technique doesn't sound that much better.

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  11. Thanks for posting bro - really helpful. I have to face the chisel soon. Very soon.

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  12. question about the obvious.....what about washing your ear out after a winter session with warm water? will it prevent bone growth? will it reverse bone growth? more for us that haven't gotten to that critical juncture

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  13. Yes, nice post. I was scheduled to get the drill at UCSD because I started getting infections in one ear (~90% closure). My hearing test came out fine, so I canceled the surgery to see if wearing ear plugs would slow or stop my problems (recurring ear infections).

    They suggested the very high priced custom ear plugs, but I tried all the over the counter plugs first. Doc's Pro Plugs were best-they do not let in water if properly fitted, didn't fall out despite some heavy hold-downs at Blacks, and they still let you interact with your friends (you can hear pretty well with them in). Of course, you might have a strangely shaped ear and they won't fit, but I know a lot of people that are completely happy with them.

    Over a year later and I've had no infections and no problems (knock on wood). I've been told that a local Encinitas guy made great ear plugs called "The Plug," but stopped making them for some reason. Anyone know about that?

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  14. This is a really informative article and probably one of the best articles on surfers ear that I have ever read. Raising this awareness is what we are also doing in the UK at www.surfplugs.co.uk I am an Audiologist, Surfers and have Surfers Ear. I developed the Surfplug to halt my own problems and this became an 'accidental' business. We are dedicated to providing custom made protection for surfers worldwide and keeping everyone (with or without surfers ear) in the water!

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  15. Thank you very much for your article. I am not a surfer, but I do have exostoses of the ear canal. I am trying to find info regarding chisel vs. postauricular procedures. Your article turned out to be a great resource! Thanks again.

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  16. Does anybody know of a surgon in Arizona using the chisel technique.
    Please email me if so.
    k9trainer@cox.net

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  17. I am an operating room nurse in Santa Cruz and I have worked with Doug Hetzler for years on surfer's ear procedures. I am also a surfer and have sent many of my surfer friends to Doug for the procedure. He has been working on perfecting his chisel method and fine tuning his tools for many years now. Our patients (my friends) have been so happy with their outcomes and are back in the water in 3 weeks. The chisel method Rocks!

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  18. I just had the "chisel" method in the UK. My surgeon was Adam Wilde, Royal Truro Hospital in Cornwall. They have been doing the Ops "chisel" style for 5 years now. No incision behind the ear, 4 weeks to back in the water. I was getting ear infections from washing my hair in the shower, and now I am back in the water no problems.

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  19. ..fantastic report man, I am glad to know all this, I have a big one on my right ear and I need to surgery, I am in europe actually but I do not have problem to move , so, now , who is the best ??...any help make me very happy !!!!!!!!thanks a lot.
    Please e mail me : ornowornever@hotmail.com

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  20. Thanks young man for your informative report!! My Doc just said my left ear is plugged!!! I've had this crinkling in my ear every time I yawn for a few weeks + now.. Had the drilling procedure done in the same ear, 35 years ago and have had ringing in my ear ever since!!! Hence I'm looking for a different procedure & have contacted Doc Hetzler about the chisel job.. Later, steve.guidephoto@gmail.com .

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  21. Hi there, I am a Manhattan Beach mom of a seventeen year old avid surfer...my son was just told he needs surgery for his surfers ear..i.have been researching surfers ear and and searching for the best doctor in la and orange county for a second opinion and came across your blog...you did not mention the doctor who performed your surgery with the chisel? Is it possible you could email me and let me know@ rcjonesfam@netzero.net

    i read about the doctor in santa cruz and am thinking about house ear but do not think they use the chisel technique...i think seventeen is way to young to have surgery!

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  22. I live up in Washington and found out that I am 75% closed. The ENT doctor was able to make a pair of custom silicone plugs for 50 bucks and they never slip once they are in. It takes a bit of getting used to sounding like Darth Vader after a big pounding but sure beats the alternative.

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  23. Just this morning had Doc Hetzler do my right ear... Really good guy... explained everything thoroughly...It's been 3 hours later and not much pain really... The ringing..tinnitus is still ther though.. Ear full of cotton ...$3100 for the doc...$2700 for the Santa Cruz Surgery center $864 for the gas man.... Will stay here a week.. Drove down from Sequim, WA No drills for me

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  24. I had a bad case of surfers ear that reversed itself after living on Maui for a few years. Yes, believe it or not, but it will reverse itself if you hang in warm water for a while. I've been back here surfing cold/cool water in San Diego for a few years now and the surfers ear is back with a vengeance. Can't hear a thing as I type this right now. Drill or chisel...decisions, decisions. Maybe I'll move to Costa Rica next time.

    Thanks for the informative article. :-)

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  25. Great article. But having had the chisel, I don't think it's better. I'm getting drilled this time. All my friends who've been drilled had faster recovery times and much better experiences. And the big downside to me, chiseling only open the canal to 80% at best. They can't get it all with the chisel. The drill gets it all. Whittaker in long beau chiseled me. It was gnarly. There's no way I'm doing that again. Sign me up for a knock out and a full bore. Hammering in your head and listening to the bones crack was way too much for me.

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  26. Geesh! Great blog. Read it all b/c I have lost 80% hearing in my right ear. It feels kinda full, like it has water, and there is a strange metallic background-not quite audible, sorta borders on tinnitus(closest thing I can think to compare is putting my ear to a conch shell - but not soothing!). So my personal research has begun. I am anxious to find out if anyone has had success without surgery, though I doubt it since it is hard tissue and can't think how it could reverse - short of a miracle...
    Any thoughts would be appreciated. I'm 54, I surf avidly here in florida, and am a performing musician; so I am praying this can be resolved enough to keep doing both. aloha!

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  27. Geesh! Great blog. Read it all b/c I have lost 80% hearing in my right ear. It feels kinda full, like it has water, and there is a strange metallic background-not quite audible, sorta borders on tinnitus(closest thing I can think to compare is putting my ear to a conch shell - but not soothing!). So my personal research has begun. I am anxious to find out if anyone has had success without surgery, though I doubt it since it is hard tissue and can't think how it could reverse - short of a miracle...
    Any thoughts would be appreciated. I'm 54, I surf avidly here in florida, and am a performing musician; so I am praying this can be resolved enough to keep doing both. aloha!

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  28. July of 1987 without the internet information was more word of mouth. I suffered a bad outcome from surgery. 40 at the time. 25 years being deaf & dizzy is life changing event. The information is of value beyond your knowing. I hope what I've learned and lived for the last 25 years remains outside of those read your blog can inmage. There are really no words for what you have done. So from one who knows, Thanks. . .

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  29. I had the procedure done by Dr Stephen Dent in Encinitas Ca. He is the best, i was back in the water in 2 weeks. I have heard tons of horror stories from friends who have gone with other drs. which made me really worried. But the entire process was comfortable and minor with Dr Dent. He's the man!!

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  30. Nick - I'm interested is chatting with you if you come back and see this. I was Dr. Dent today and need the surgery ASAP to cure my condition of 100% closed ear with infection and bone beginning to press on the facial nerve (crazy bad stuff i know) I've been wearing earplugs for 8+ years hoping to avoid this but was informed today it would have been easier/better to have this done years ago.

    my email;

    ptornillo@cox.net

    Thank you and thanks for this site and thread !

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  31. 33 days from surgery to back in the water. My left ear which was 98% closed is full clear and I can hear better today than I have in the last 15 years. My right ear which is 99% closed is scheduled to go under the drill Sept 20 again with Stephen Dent MD of Encinitas. Dr. Dent is nothing short of awesome.

    -Paul

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    Replies
    1. Paul,

      I'm a 58 years old Brazilian guy, with exostoses in both the ears. Please, I would like to know the method Dr. Dent used in your ears, was it micro drill or chisel? my email is lcacaio@terra.com.br

      Thanks,

      Luiz Carlos

      Delete
  32. I live on the NJ shore just north of Atl City and both ears almost closed. Don`t want to fly to Ca for this hassle, either drill or chisel Anybody out there know of a doc near Philly who does this? What, I can`t hear you. This sucks! The Dent Dr. sounds good. Should have booked this early Aug to coordinate it with Del Mar but stupid me instead went to Saratoga -Jeff
    Jponyplayer@aol.com

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  33. 7 days since I had the right ear drilled (Sept 20th). I am pretty much off the pain meds. Tomorrow I get the antibiotic gel extracted from the ear so I expect to finally be able to hear. I've spoke with 2 guys who have had the surgery twice (only 1 ear I think) and yet the bone growth and discomfort (water stuck in ear) has returned. Both of these gentlemen shared that they have never worn earplugs. I'm 47 and likely had most bone growth from ages 20-35 when I surfed almost every day and did not wear earplugs. I wore earplugs (silicone variety) from 36-47 with no issues until last May when I had the mother of all ear infections. Believe me when I say I was totally incapacitated for days and knew I never wanted that again. The problem with Extosis is the bone growth occurs and water/bacteria can get in but it cannot get out. I had the surgeries for one reason - so I would not get that knarly incapacitating infection again. The better hearing is merely a bonus.


    I will say that after much research the new "micro drilling" technique is not perfected by all ENT's. Chiseling and cutting back the ear is not the preferred or best method any longer.

    Feel free to email me if you want to chat about my experience.

    ptornillo@cox.net

    Wear those plugs surfers!

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  34. Just got cleared for water today. 3 weeks to the day from surgery. Pretty surprised yet stoked. The other ear was 33 days.

    ptornillo@cox.net

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  38. For all you non-surfers out there who are reading this, I had surgery yesterday on my right ear, and wanted to offer a few thoughts. First, this is an excellent resource, and I especially want to thank Paul above for his personal response. I had my roughly 1/2" round growth removed with a chisel through the ear canal, which was especially great since my ENT thought it was highly likely he was going to have to do an ear slice. Secondly, if you've never surfed or had a lot of repeated exposure to cold air or water, you can still get these. There appears to be debate in the medical profession as to whether there is a significant different between the terms "exostosis" and "Osteoma". Some appear to use them interchangeably, some differentiate based on the shape of the growth. Mountainous growths with broad bases, especially multiple and bi-lateral, seem to earn the term "Exostosis" whereas single, unilateral growths, on stalk-like (Pedunculated) bases seem to earn the term "osteoma." But it seems to matter little since the treatment path is virtually identical. If you live somewhere where these are not commonplace, and you can't find a doctor with a lot of experience with them, try to find a well respected ENT who has experience with drills, chisels, working through the canal and doing the ear slice if necessary, and the wisdom to know when to use what technique. It appears the presevation of the ear canal skin is the most important objective after successful removal of the growth. My doc was James Ragland out of Rogers AR. At the 24 hour mark, I couldn't be more pleased. No pain, no meds, and even with the ear packed, I can hear more today than I could before the surgery. Thanks to all who posted here and best of luck to those who are trying to figure out the best path for yourself.

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  39. 61 years old and surfing California since 1962 my left ear finally close up. The final closure started after a camping trip to Yosemite in August and swimming under water in the icy river. It started to open and close and I got it vaccumed the first time and it worked, next time nothing.
    The doc said you know what you need to do......I found Dr. Paddie in Mission that uses the chipping method. The surgery was 10 days ago, absolutley no pain ever. The gel in ear and having to work was not easy. Gel removed today and I can hear, but it still feels closed. Dr. Paddie says it is still swolen and still has 10 % gel still there. I was thinking once the gel was removed it would just open, but I guess I need to wait a bit. Will come back on this blog and let you know. Dr. Paddie in Mission Viejo is good though. I recommend him if you are looking for a very experienced doctor who knows what he is doing.

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  40. Thanks mate great info for us all. My lefty was drilled 15 years ago and been drilled again 12 weeks ago, its gone bad now, infected and blocked with scar tissue my ENT surgeon says, so deaf again...right ear at 95% closure, going quietly crazy in my own head, all this after being attacked by a shark on Jan 18th 2012, this is the icing on the cake...over it...

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    Replies
    1. Glen - read your post on your ears. Bi hope they have been resolved. I had my right done 8 years ago. The my left went bad about a month ago. Just had it done about two weeks ago and I now need my right done and am having the right done again. I am now going nuts In my head hoping that the second surgery equalizes the presure. The completed ear opens for awhile and then closes again repeatedly a week following the surgery and the left does the same. The hearing and presure changes are driving me nuts. Did you experience anything similar.

      Delete
  41. Hey I just had my gnarly 98%er's out by laser and quiet diamond drill. Guess what a 15 year guarantee they won't come back!!! Ya I wrote Corky Carroll and he said Dr. Carol Jackson's best in Newport Beach. He had 3 before she got him straightened out-1 surgery on each side. Google his articles. Dr J's the bomb has did 400 plus 20 office 50% clearings. When we were coming & going, an east coast dude 5 yr was there to check his other ear and 2 guys wanting re-do's from chiseling were signing up.//

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  42. I live in Michigan, so not a surfer. But was a competitive swimmer while growing up and still like to swim. I had my right ear chisled about 8 years ago. It was pretty uneventful and things went back to normal pretty quickly. Over the last Labor Day weekend my left ear got water in it that wouldn't clear. Which led to the right one being chisled out. Following surgery while I had the packing in my hearing in the left ear felt at times similar to when descending in a plane. Under presure and muffled and at times I was essentially deaf. When the packing was taken out about a week ago my hearing and the presure comes and goes at times in both ears and it's driving me nuts. I am wondering if anyone else has had this issue during recovery from the surgery? I also need the right done again now and am scared as the left one is not back to normal. I am now wondering it the lack of airflow in the bad right one is causing the presure like symtoms I have . Any feedback on post surgery for this would be appreciated.

    ReplyDelete

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