Surfer's ear and earplugs
6 min read
Surfer's ear is bone that grows into the ear canal after years of cold water and wind. The lumps are called exostoses. They are benign (harmless in themselves), but they narrow the canal, trap water and wax, and in the end can block it. Once the bone has grown it does not go away on its own. That is why prevention matters.
What causes it
- Cold water and cold wind, repeated over years. Doctors describe it as the body's reaction to the canal being chilled again and again. Wind adds to it by cooling the wet ear by evaporation; a study at Bells Beach in Australia found more growth in the ear more exposed to the wind.
- How cold: UCLA Health say it is most common where the water is in the mid-60s °F (about 18 °C) or colder. A Canadian medical journal review puts the main risk at water below 19 °C. Warm water is not a free pass: surfers on Australia's Gold Coast (20 to 28 °C) had it about as often as surfers in colder Victoria, though severe cases were about half as common.
- Years in the water. Risk rises with years of surfing, winter surfing and how often you go out. A study in England found the risk rose clearly after about 6 years of surfing.
- It is not only surfers: cold-water swimmers, divers, kayakers and sailors get it too.
How common it is
Very common among cold-water surfers. Studies give different numbers because they look at different water, ages and levels of surfing:
- Bells Beach, Australia: some narrowing in 76% of 300 surfers and spectators examined; a third had two thirds or more of the canal blocked.
- Cornwall, UK: 63.8% of surfers studied.
- Brittany, France: about 90% of the surfers examined had some growth.
- New Zealand: 29% lifetime prevalence in one study of surfers.
Signs to look out for
Early on there are usually no signs at all. They start when the canal is already narrow:
- Water that stays trapped in the ear after a surf, and takes hours to drain.
- Muffled hearing, a blocked or full feeling in one ear.
- Wax building up and blocking the ear more often.
- Repeated outer-ear infections (otitis externa): pain, itching, discharge.
- Ringing in the ear (tinnitus) can occur.
Only a doctor can tell whether you have exostoses, by looking into the canal. Many other things cause the same symptoms.
Prevention
The aim is to keep cold water and wind out of the canal. Royal Cornwall Hospitals put it plainly: using earplugs in the water is always preferable to surgery, and even with a narrow canal, many people avoid blockages and infections by keeping water out with plugs.
- Earplugs every cold session, not just in winter. A French study of 242 ears found that time in the water without protection was linked to more severe growth, and time in earplugs was not. A 2022 review in the Medical Journal of Australia says plugs appear to slow the growth and lengthen the time before it comes back after surgery, though some studies found no difference.
- A hood keeps wind and cold off the ear in winter. The evidence is mixed: a study from England found plugs or a hood reduced the risk, while the French study found hood time on its own did not protect. Many cold-water surfers wear both.
- Dry your ears after the session. NHS advice for outer-ear infections suggests a hairdryer on a low setting, held well away from the ear.
Types of earplugs
- Acoustic surf plugs (SurfEars is one example) have a mesh or channel that lets sound through and keeps most water out, so you can still hear the lineup. They come with tips and wings in several sizes. Some users find hearing drops when water sits on the mesh.
- Vented pre-formed plugs (Doc's Proplugs is one example) are soft plugs with a small hole for sound and pressure. They come in many sizes, marked left and right, and need fitting; a neck leash stops you losing them.
- Custom-moulded plugs are made from an impression of your ear by a hearing-care professional. They fit closely, but a 2011 study found hard custom plugs muffled hearing the most, and soft pre-formed plugs the least.
- Mouldable silicone putty plugs, sold for swimmers, are another simple way to keep water out; NHS advice on outer-ear infections mentions silicone earplugs.
- Whatever you use, it should seal without pain. Try sizes; your left and right ears may need different ones.
When to see a doctor
- Water often stays trapped in one ear, or your hearing feels muffled after surfing.
- You get outer-ear infections again and again.
- Ear pain, discharge, swelling, a fever, or hearing loss that does not clear.
- A GP can look into the canal and refer you to an ear, nose and throat (ENT) specialist if needed. Infections are treated with ear cleaning (microsuction) and drops; that may be enough for years if you then keep water out.
If it needs an operation
Surgery is for canals that are badly narrowed and keep causing infections or hearing loss. It is called a canalplasty. In brief, from NHS and specialist patient information:
- Done under general anaesthetic, often as a day case. The operation takes about 1.5 to 3.5 hours.
- The surgeon works through the ear canal or through a cut in front of or behind the ear, and removes the bone with a small drill, a chisel (osteotome), or both.
- Drill or chisel: both are in use and surgeons have preferences. The 2022 Medical Journal of Australia review links modern drill techniques with fewer perforated eardrums, jaw-joint problems and canal-wall fractures than older chisel techniques. Ask your surgeon which they use and why.
- Risks include pain, infection, a perforated eardrum, damage to the jaw joint, hearing loss or tinnitus, and, rarely, damage to the facial nerve. The canal can also narrow again from scarring.
- The ear is packed for about 2 to 3 weeks. It must stay dry until your surgeon says so. Royal Cornwall Hospitals say that may be up to two or three months; a New Zealand ENT clinic says water sports are usually fine after about 8 weeks, sometimes 4. Plan on weeks to months out of the water.
- It can come back with more cold water. Wear earplugs every time once you are back in.
In the app: This guide is general information, not medical advice. If your ears hurt, ring or feel blocked, see a doctor.
Sources: Royal Cornwall Hospitals NHS Trust: Surfer's ear (patient leaflet, PDF) · Royal Cornwall Hospitals NHS Trust: Canalplasty / excision of exostosis (patient information, PDF) · Medical Journal of Australia (2022): From wipeout to drill out, a history of exostosis management and Australian surfing · UCLA Health: Surfer's ear occurs due to cold, wet conditions · Lambert et al. (2021), Eur Arch Otorhinolaryngol: Impact of ear protection on occurrence of exostosis in surfers, 242 ears · Marjon University: The effects of surfing behaviour on the development of external auditory canal exostosis · ENT Associates NZ: Canalplasty for exostoses removal · RNID: Exostosis (surfer's ear)