Dr. O’Leary describes the difference between swimmer’s ear and surfer’s ear.
They ask about it all the time. That sounds the same, doesn’t it? They both involve water, but they are actually two very different pathologies, the problems that cause this.
Swimmer’s ear is very common. When you have the kids in the pool in the summer, or you are swimming yourself, irritation in the water, it’s not pure water, it’s got bacteria in it – E. coli – both in the ocean and the pool these days, can actually set up an infection. And the more we try to treat this with regimens that we think make sense in this extremely delicate area that is the outer ear canal, we mess things up.
So we get the bacteria in; it goes on to be an infection, etcetera, and all the topical treatments are bad for this. The real answer here is just to, when you get out of the pool with a healthy ear, wash it with some clean water like you would drink.
If people ask you what you are doing, you tell them you are really thirsty and see what they look like, but the truth is you are washing out the bad stuff and what evaporates and is left there is nothing bad, and just dry it with the towel and nothing in that.
Any alcohol, peroxide–all the regimens that swim coaches and other well-intentioned, but ignorant people, of the uniqueness of this anatomy profess, gives us real trouble. And then the other thing that makes it sort of a vicious cycle is that when bacteria, particularly fungi become part of the problem. So eardrops that knock out the bacteria, you are left with a bunch of fungi and their primary first symptom is itching.
So the more it itches, the more we go in, and the next thing you know you got a vicious cycle that’s leading to infection, and a couple of infections year after year thinking there is something wrong with the water. That’s really the least part of it; it’s the person is making the problem.
So you adapt a more natural way of keeping your ears clean. Water and shampoo in the shower and then just a rinse, a douse when you get out of either the pool, the ocean, and you will swim all summer very happy.
Surfer’s ear: same water, totally different problem. Surfer’s ears are really interesting condition. In Surfer’s ear, particularly in southern California here where we see a lot of this, and I have treated both Navy divers from my career in the Navy and now a lots of patients who are even professional surfers having this problem.
Cold-water exposure has a very unique response in the outer ear canal. The bone that you see here will actually gradually grow and close off the ear completely in a protective reflex that has baffled us for many years. It’s a hereditary piece; it doesn’t happen to everybody, and we have a hard time figuring out what could possibly be the advantage of the ear narrowing-off like this.
Well, a study done just recently has provided some real insight to that in my mind, and it was an archaeological study. They went and looked at the skulls from Indians living in the Amazon basin, and so there’s two groups of Indians who had come from very different regions. One group had come from the Amazon at ground level and settled by this body of water on the east coast of the South America.
The other group had come down from the mountainous climes in the Andes and settled in the same neighboring area, both exposed to the same water. When we look at the skulls of these two groups of Indians, the population from the jungle, sea level, had almost none of this bone closure we call exostoses. On the other hand, those from the Andes Mountain, 70, 80, 90% of the same problem.
This suggests that there was some adaptive advantage, and what this probably comes from is the Ice Age. For thousands of years, people in the mountains were able to survive by mitigating the effects of the very cold weather and part of that was to close the ear canal, allowing less of the thermal transfer of this cold air to the inner ear. That is not an adaptive advantage that helps us in any way now, and for the surfers it creates a real problem.
A couple of things to know about Surfer’s ear. First thing is, if you have it, it’s congenital. It’s hereditary. You are going to get it. If you stay in cold water, you are going to close off the ear canal. So you’ve got to stop this early, and the best way to do that is the little plugs that we make that are actually form-fitted, like hearing aids would be, that you wear while you surf.
The effect of that is it doesn’t need to keep the water out; it just needs to restrict the amount that passes through like a wet suit. You get wet when you hop in the water with a wet suit, but the water is so little that the body can heat it up, and as a result, the warm water does not stimulate the ear bone like the constant flushing of the open ocean does. That’s the best way and that prevents problems.
Once the aperture, or opening of that ear canal gets down below about 90% blockage, so you’ve only got 10% left open, that’s time you have to have a surgery for this.
We dive into the surgery of this. There’s a whole bunch of ways to do and a lot of fallacies and misinformation out there. The bottom line, if it’s done well, it’s a one-time operation. From that point forward you know you’ve got an addition; you use the plugs.
I’ve never had to repeat this surgery ever, but I have done hundreds of cases, both in my Navy population of divers and underwater experts and now more recently in my private practice operation of people who are avid surfers, including professional surfers. The goal is to get the ear to look just like it did before this all started and there’s a lot of technique parts of that that are very important.
So, one, an unusual condition really challenging to be managed well, and the second one, very common and just a poorly managed hygiene; that’s really the difference between the two.
About Dr. O'Leary, M.D.:
As a neurotologist, Dr. Michael O'Leary specializes in diseases of the ear and balance, treating all aspects of ear problems, both medical and surgical. Among his unique areas of expertise in the ears are correction of surfer’s ears (exostosis), stapes surgery and repair of chronic mastoidectomy defects. His role on the skull-base team focuses on tumors of the lateral skull base, such as acoustic neuromas and meningiomas. He is also a nationally recognized leader in the development of minimally invasive techniques, including the endoscopic removal of pituitary tumors.