Cold water swimming, paddleboarding and surfing are all popular pastimes - with millions of people in the UK regularly participating in at least one type of outdoor watersport each year.
Author
- Dan Baumgardt
Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of Bristol
But those bravely breaking the waves may not realise they could actually be putting themselves at risk of hearing loss due to external auditory canal exostosis - better known as surfer's ear.
Surfer's ear affects the auditory canal - the thin tube which conveys sound waves from our surroundings, channelling them towards the sensory organs which generate our sense of hearing.
These inner portions of the ear are shielded by bone. This is because the anatomical structures that turn air pressure waves into sounds - the eardrum , ossicles and cochlea - are very small, very sensitive and would be easily and irreparably damaged if not protected.
Ideally, our ear canals should be clear and unobstructed. Sure, sometimes they can get clogged up with wax and even sometimes foreign bodies can work their way inside (such as peas, plasticine or even bugs).
But surfer's ear causes an obstruction of the ear canal in a different manner. Growths start to develop on the bone which lines the auditory canal.
As these growths continue to develop, they push into the canal - effectively narrowing the space inside. In doing so, this can prevent the conduction of sound waves getting through to the eardrum. One symptom patients with surfer's ear may notice as a result is hearing loss .
Other associated problems may arise, too. The ear canal produces wax. Any narrowing of the canal will more easily retain wax, but also water - not just from swimming, but from wet weather or taking a shower. An accumulation of both in the canal can worsen hearing loss and raise the risk of developing an ear infection .
But what causes surfer's ear in the first place?
The cause appears to lie in repeated exposure to cold water and high winds - which most surfers encounter while riding a wave, or tumbling off one. It appears to be a problem unique to humans, perhaps because of the configuration of their ears.
While researchers aren't entirely sure why cold exposure causes the bone to grow abnormally, it's possible that the ear's natural response to prolonged cold (which irritates the eardrum) is to create a bigger shield for it. Cold water and wind may stimulate bone cells called osteoblasts , causing new bone to grow - offering more protection.
It's important to note that surfer's ear is different from swimmer's ear - a condition which you may be more familiar with. Though both can arise from water immersion.
Swimmer's ear, also called otitis externa , is a form of ear infection. It typically results in pain and discharge, and can arise from water accumulating in the ear canal, which then acts as a breeding ground for bacteria. Narrowing of the ear canal can worsen the problem, so swimmer's ear can also be associated with surfer's ear.
It's estimated that 3-6% of the general population may have some form of exostosis. But the condition does appear to overwhelmingly affect surfers - with one systematic review finding the condition affected an average of around 68% of surfers .
However, surfer's ear is not unique to surfers. Any sport which exposes an athlete to cold water and wind might result in the same effect. These include wild or outdoor swimming , windsurfing and kayaking .
There's also a cultural and geographical difference in prevalence across the globe. It's estimated that 10% of Australians surf, and potentially raising the risk.
You don't even have to venture into the water to develop surfer's ear, either. Some research suggests people living near the coast have an increased risk of developing surfer's ear as they're more likely to be exposed to cold winds. Other cases have been observed in patients without a clear cause.
The condition might also be more common in males - though this may be due to a larger proportion of men participating in both the sport and the research.
Preventing surfer's ear
Some research suggests that using earplugs while in the water can help reduce cold exposure to the ear and lower the risk. There are also specialised hooded wetsuits and bands that can worn as further protective measures.
Surfer's ear appears to be a long-term complication, and is more likely to develop from regular exposure, not just an occasional cold water dip. More than ten years of surfing appears to be associated with a greater risk, and more severe canal obstruction.
For patients who develop severe symptoms - such as hearing loss and persistent ear infections - surgery may be required . The operation, called a canalplasty , involves chiselling or drilling away the excess bone to widen the canal again. Surfers should avoid heading back into the waves for two to three months after the operation until the site has properly healed.
There's some indication surfer's ear may be on the rise - though this could also be because we're getting better at diagnosing it and nowadays more surfers are aware of the condition.
The risk of developing surfer's ear in one or both ears is sadly real. Unfortunately, it appears that only by abstaining from surfing can the condition be averted.
So if you do plan to go out into the wind and water - whether that's surfing, paddleboarding or wild swimming - don't forget your earplugs.
Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
