Surfers return to the ocean sooner after faster healing

The sounds of the sea—waves crashing, gulls crying—are muted in some of the ocean’s most frequent visitors, surfers.

An international surfing mecca, Santa Cruz is also distinctive as a world center for “surfer’s ear,” a serious condition that affects hearing.
Medically known as exostosis of the external auditory canal, surfer’s ear is caused by repeated exposure to cold water and wind. Cooling of the ear canal stimulates bone growth that narrows the canal and blocks the eardrum. This narrowing traps water and earwax in the canal, often resulting in painful ear infections and hearing loss.
Douglas Hetzler, M.D. an ear, nose and throat specialist at the Santa Cruz Medical Clinic, is one of a handful of California physicians using a minimally invasive technique to remove such bone growth. Dr. Hetzler’s technique was refined from a procedure he first heard about from a now-retired surgeon in San Diego. He now presents the technique to other specialists in the United States, Mexico and, in May will be at the Australia Society of Otolaryngology, Head and Neck Surgery.

Over the last five years, Dr. Hetzler has successfully operated on 90 ears by entering the ear through the ear canal and using tiny one-millimeter chisels.
Two of those ears belonged to Steve Spiliotopoulos, a well-known water sports enthusiast and manager of O’Neill Surf Shop in Santa Cruz.
“I’ve been in the water for 30 years, since I was five—swimming, boogie boarding, surfing and doing underwater photography from a dive boat. The cold water took its toll with over 95-plus per cent closure in each ear,” he said. “I would get earaches and infections from trapped water.”

In January of 2002, Spiliotopoulos “bit the bullet” and underwent the surgery that he compares to oral surgery. “I was in and out the same day, had muffled hearing, throbbing and headaches for a couple of days, then was back to business as usual in four to five days, except for getting back in the water right away.”

“I’m very happy with the procedure and Dr. Hetzler’s follow up,” Spiliotopoulos said.

In Dr. Hetzler’s practice, using chisels to remove the ear canal exostoses via the ear canal has replaced the traditional incision behind the ear and all or most use of a drill. The advantages for the patient are less exposure to noise during surgery that can damage hearing, more rapid healing and a faster return to water sports.

“This technique is well suited to a specific problem that is prevalent here,” Dr. Hetzler said. “This surgery can be difficult because it’s like looking through a keyhole, working in a space that is no bigger than seven millimeters—the size of the end of your little finger at most. It is always meticulous, but kind of nerve-wracking. With this technique, it is still intense but a little easier.”

His technique also benefits from a microscope “so state-of-the-art that there aren’t too many available in the country” that was recently purchased by Sutter Maternity and Surgery Center.

How can surfers (and ocean swimmers) avoid surfer’s ear?

“This condition develops over years of exposure to the cold,” Dr. Hetzler said. “I’ve operated on people aged 25 to 85 for this condition, but most surfer’s ear sufferers are in their late thirties. Prevention is as simple as wearing earplugs and/or a neoprene hood when surfing or swimming in the ocean.”

A board certified otolaryngologist, Dr. Hetzler treats a full range of ear, nose and throat conditions for children and adults.

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