I sat on my surfboard in the water slouching my back to the crisp offshore winds, watching Bruce Swanson down the beach duck dive under another closeout and paddle beyond the breakers. He wedged himself onto his board, cocked his head to the side, stuck his arms out, and shook his head. Then he stopped and pressed his hand over his ear. Warm under my hood, I turned back to the horizon, scoping the next set.

Great waves were hitting our favorite sandbar, but our buddy Kelsey Hoult was missing out on this session in Estero Bay. He was in the operating room in Orange County.

Hoult left Arizona for the Central Coast two years ago to surf. We would be surfing all weekend and despite the cold conditions, he did not bother to wear a hood. He never wore one throughout all those years surfing Columbia River Gorge, Oregon, in his teens either.

It was not long before he noticed he was having difficulty clearing water from his ears after a surf. Then he noticed it happening every time he surfed.

Hoult’s ears were becoming plugged, trapping dead skin, sand, water, and anything else in the local sea water.

Unbeknownst to him at the time, he was displaying an early symptom of exostosis, or “surfer’s ear.” And in Hoult’s case, it set in fast.

Strangely enough, surfer’s ear is actually the body trying to protect itself. Face it, the human ear doesn’t like water and wind, so it builds a wall of cartilage in the canal just before the eardrum. This narrowing of the ear canal is called “stenosis.”
Left untreated, exostosis in the ear canal leads to infections, swelling, discomfort, a not-so-pleasant odor and ear drainage. Failure to treat a worsening condition can go so far as to result in a staph infection or meningitis.

“I went from my ears feeling fine to getting water stuck in a matter of weeks,” said Hoult.

After surfing through summer, Hoult suffered an ear infection in October.

“It feels like you’re sick,” Hoult said. “Your head is pressurized the whole time you’re surfing. It’s no fun.”

He saw a doctor in San Luis Obispo who uttered the term “surfer’s ear.” A second doctor confirmed what the first had said: Hoult had an advanced case of exostosis.

Surgery.

Hoult felt that cold, dirty Oregon water wash over him again like the northerly storm swells from his youth. How many times he paddled out into the rivermouth, braving the thick, icy shorebreak without a hood.

He went home for a week and researched exostosis online. He learned that good-fitting earplugs are the best defense, but even a hood helps.

He read horror stories of patients who had surgery on their ears. Some described how the doctor sliced into the back of their ears with a scalpel, folded the whole thing forward like a tortilla, and drilled a hole through the bone.

He read stories told by Australian surfers whose surgery had gone wrongóthe doctor touched a facial nerve, causing half the patient’s face to collapse and an eye to go blind. “I’d rather be dead!” wailed the victim.

“This is not something to be done by the cheapest doctor you can find,” thought Hoult.

One night, Hoult read about another, newer procedure involving a laser. He also found Dr. Carol Jackson from Orange County and made an appointment.

Dr. Jackson runs an office in Newport and only uses a modern technique, which is performed completely through the ear canal without an incision behind the ear. An outpatient surgery requiring only general anesthesia, it usually has patients returning to their normal, land-based activities in one or two days, Jackson explained. Surfing is resumed within two months, but it takes up to a year for the ear canal to completely heal.

Later in October, Hoult drove down to Newport. Dr. Jackson sat him down in front of a TV monitor, snaked a fiber-optic filament microscope and camera into his ear, and for the first time Hoult was staring right into his ear canal. It took but a glimpse for both of them to see that Hoult had 95 percent closure of his right ear. His left ear was slightly better at 90 percent.

“The whole thing was totally closed and there was a pinhole for sound to get through,” he described.

Dr. Jackson snapped a few photos of his infected ear canal then scheduled an appointment for the surgery to take placeóin nine months.

“She didn’t act like there was any mystery at all,” he said. “She told me ëwax is your friend!’

Your ear wax is actually a water repellent, and like you wouldn’t strip the wax off your car and take it to the beach, you don’t want to strip the wax from your ears either.

Full of knowledge about ear holes, Hoult waited for June. He returned to Newport for his first surgery. It was to be one of two. The left ear would have to wait for later in the year.

June arrived, and Hoult showed up on time at Dr. Jackson’s office. He was shown a changing room where he had to put on “a gown with your ass hanging right out.” He was offered but declined anti-anxiety medication. Then, nurses took a blood sample and lay him on a bed hooked up to an I.V. Dr. Jackson entered the room. She had on her game face. She was wearing scrubs and looked entirely different than the first office visit.

“Umm,” Hoult stammered, “I think I am going to need those meds after all.”

Once relaxed, Hoult watched the anesthetic trickle down the tube into his vein. Dr. Jackson inserted acupuncture needles into his cheeks and forehead and hooked them up to a computer to monitor his facial nerves.

Kelsey laughed, “The last thing I remember is announcing, 'Yeah so I feel this is a good team, girls! We’re gonna take care of this thing this is great!’”

“Alright, you’re done!” Dr. Jackson was singing already.

As soon as the anesthetic haze wore off enough to stand on two feet, Hoult was driven back to a hotel room by his wife, and he slept for eight hours.

He stayed out of the water for two months, and the ocean, as if sensing Hoult’s condition, stayed flat, too. But it wasn’t long before autumn arrived bringing avalanches of swell from the north, and we were surfing together again. That is, until today the day of Hoult’s second surgery.

I phoned him yesterday, and he sounded good.

“I’ll be so stoked when it’s over with! I go down on Wednesday to get worked,” he said, relief audible in his voice, but there was a pause before he continued. “I feel like I was let down by surfing: I was buying wetsuits and booties and other stuff; why wasn’t there anybody telling me to buy a hood?”

Boy, did Hoult learn a lesson and teach his friends one at a time. We all bought hoods, and the smarter ones have gotten our ears checked by a doctor. Now when Hoult is receiving the rinse-cycle treatment by the Pacific, he’s got a double defense: a hood and neon green earplugs.

Which isn’t what Swanson is wearing, I think. I turn my board and scratch for the sky as he continues to pound the side of his head with his fist. He doesn’t see that set coming.

Dr. Jackson does not recommend waiting to see a doctor if you experience the symptoms of surfer’s ear. This article contains general information and is not medical advice to any particular individual or a substitute for an examination and treatment by a physician.

Tips from Dr. Jackson on Protecting your Ears:

• Alcohol removes the body’s necessary natural skin oils and ear wax; don’t put it in your ear. That includes mouthwash (true story). There are blow dryers available which are fitted with comfortable ear tips to dry out ears after a surf session.
• Over-the-counter preparations for wax removal can trigger allergic reactions with painful blisters.
• The odd practice of candling can push wax deeper where the ear cannot extrude it.
• Don’t use cotton swabs or a washcloth and soap to “clean your ears.”
• If your ears itch, don’t use cotton swabs, bobby pins or pens to scratch them.

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A cautionary tale
A 28-year-old man was plugged in one ear with hearing loss for years and so fearful of needing surgery that he waited until the other ear was completely plugged for weeks and painful before seeking medical attention. We all celebrated when we “uncorked” his ears in the office! He had small exostoses but impacted inch-long solid wads of cotton fibers and bits of foam and wax mixed with sand, skin and his own dried wax. It took two hours to remove the virtual casts of his canals but he was happy, and I neither saw nor heard from him again. I figured the impactions acted like earplugs, but that’s not a recommended way to go! We gave him some silicone ear plugs to try instead. 

– Dr. Carol Jackson