Have questions about Surfer's Ear? Dr Martin Young answers all your questions below.

Do I need the surgery?

Well, you have to be the one to make that decision. The benefits of surgery have to outweigh the risks and negatives. Only you know how much of an issue your ears are to you.

If I already have the symptoms associated with Surfer's Ear - what are the risks if I delay surgery?

The most significant risk is that you reach a point where avoiding the surgery is no longer an option due to your discomfort, hearing loss and repeated ear infections affecting the everyday quality of life. At this point, the risks of surgery may now be significantly higher, because the exostoses are bigger and require 'more' surgery under a more difficult situation where your eardrum may no longer be visible. In this instance, your surgeon will be working 'blind' as to the location of your eardrum for the first and most crucial part of the surgery, and the risk of injury to your facial nerve, jaw joint, eardrum and middle ear structures are highest. These concerns are as significant to your doctor as they are to you. While complications are rare, the worse your situation is, the more likely they are to occur. A 'difficult' operation can take more than twice as long as 'easy' operation. With theatre time costing as much as R300 a minute, this is a consideration for people who are not insured in any way for the surgery.

At which stage of Surfer's Ear does the surgery become more complicated?

While your eardrum is still visible past the exostoses, the surgery is more straightforward. Once the exostoses reaches a point where it completely closes the ear canal, the surgery is harder to do. Not impossible by any means, and I still operate on those who want the surgery, but the procedure is more significantly more difficult.

In essence, the sweet spot for having the surgery is when you start developing symptoms of Surfer's ear, but before your ear canals are completely closed.

How long does chisel surgery take?

It depends on how much bone must be removed, and how close the exostoses are to the drum. A rough estimation would be around one hour per ear. However, this varies per patient and the severity of the case.

The relevance of this question is that many hospitals charge per minute for the time in a theatre unless your surgeon has negotiated a fixed rate beforehand. As I generally do. This has obvious implications on the cost of the procedure. On average, the chisel procedure takes two hours which is substantially less than the time required for surgery using the drill.

Which ear do you do first?

I prefer to do the ear causing more symptoms first, on the assumption that it will be the trickier ear to do. If all goes well with that side, and with your agreement beforehand, I do the other ear at the same sitting.

Do I need to stay in hospital overnight?

No, you would only need to stay overnight if you have an adverse reaction to the anaesthetic, with pain or nausea and vomiting. The vast majority of patients leave the hospital the same day.

When and why do I need a follow-up after surgery?

The biggest challenge in this surgery, and one we are still working on, is how to dress the ear canals after the operation with a minimal amount of discomfort and blockage so that healing takes as little time as possible. 

The purpose of any follow-up check-ups is to remove blood clots and scabs and to get you back to normal as soon as possible.
The absolute minimum is a check-up three days later to remove blood clots and dressings. The ideal would be another consultation about a week after the surgery. Those whose schedules do not allow this should ideally have a backup with an ENT in their home towns. 

This consultation would be to remove crusts and scabs that are an inevitable part of healing. These will disappear without intervention, but this takes a bit longer.

Will the exostoses grow back?

Bluntly put, if you do not use earplugs while in the water or wear a hoodie afterwards, yes. If you were unlucky enough to get them in the first place, they will come back again if you do not remove the cause, the 'wet-cold-wind chill' cycle that caused them in the first place.

Do medical insurers cover the surgery?

This is dependent on your medical aid provider and scheme. In general, they do unless they can show that you signed up with them with a pre-existing condition. In which case, it may be declined. The amount they payout is dependent on your policy. Usually, the hospital fees are covered in full, and this is about half the total cost. The surgeon and anaesthetist fees are generally not included in full, and I highly recommend that you get quotes and negotiate fees beforehand. For those who can, 'gap cover' is the affordable insurance option to cover those 'self-payment gaps.'

What can I expect after surgery using the chisel technique?

For most people, the worst thing to deal with will be a minor degree of discomfort and blocked ears for three days after surgery until the dressings are removed. Some patients find the surgery painful, but these are the minority, and medication is available to deal with this. Unfortunately, I have no way of predicting who those people might be. Ringing in the ears - tinnitus - is common but will disappear as your ear canals heal.

How long after surgery before I can get back into the water?

I suggest you wait until the canal swelling is entirely down, which takes about two weeks. As long as your ears are protected with earplugs to keep seawater out, surfing again after this time shouldn't be a problem. You will be using ear drops regularly for at least a month after the surgery.

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