Better Wetsuits Lead To Deafness In Surfers

The incidence of deafness in surfers is increasing due to improvements in wetsuit design. 'Surfers Ear' or cranial exostosis is caused by cold air and water entering the ear causing bony outgrowths to grow in the ear canal, gradually closing it over and causing deafness. The emergence of higher performance wetsuits over the last few years allows surfers to spend longer in the water in colder conditions, making surfers' ear much more likely, as well as more severe.

According to Wong and colleagues (1) there is a direct relationship between the occurrence and severity of surfers' ear and the amount of time spent in the water. According to their work 16% of avid surfers have narrowing which is severe enough to cause significant hearing loss.

The narrowing can be treated with an unpleasant operation where the bone is either drilled or chiseled away but this doesn't stop the condition recurring if the necessary precautions of wearing a cap and surfers' ear plugs aren't followed. Ear plugs for surfing prevent the cooling effect in the ear canal and a neoprene cap prevents the cooling of the mastoid bone behind the ear which is also associated with the development of the condition.

As well as deafness, surfers' ear can cause repeated ear infections because the narrowing of the ear canal slows the evaporation of water and increases water-logging. This damages the skin and allows bacteria to enter resulting in otitis externa, also known as swimmers' ear.

Repeated exposure to sea water washes away protective oils which are naturally present in the skin, allowing the water to reach the surface of the skin; squamous epithelium. The water softens the skin, and eventually penetrates, carrying bacteria with it. It colonizes the skin, causing external ear infection which shows itself as itching, redness, soreness, pain and discharge. This is also known as 'swimmers ear' or otitis externa and is easily treated with ear drops containing a combination of steroids, antibiotics such as gentamicin and an antifungal such as acetic acid (vinegar).

Left untreated otitis externa can spread and cause otitis media, middle ear infection. This tends to be more painful than otitis externa due to the pressure that builds up behind the ear drum. It can temporarily or permanently affect hearing and is more likely to cause significant discharge than external ear infection. It is treated with ear drops and antibiotics taken by mouth.

References: (1) Prevalence of external auditory canal exostoses in surfers'. Arch Otolaryngol Head Neck Surg. 1999;125:969-972.

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