Microchisel Exostectomy
Removal of exostosis, or “surfer’s ear”
New Zealand is an island and our fantastic coastlines lend themselves to year-round water sports. Resulting exposure to low water temperatures, combined with wind chill, has been associated with external auditory canal exostosis, also known as “surfer’s ear”. This condition is characterised by multiple, bilateral outgrowths of bone in the ear canal.
The main reason for exostosis surgery is recurrent external ear infections. These infections can be difficult to treat because of the narrow ear canals preventing penetration of topical antibiotics and effective micro-suction.
History of Exostosis Surgery
Exostosis surgery has been performed for over 100 years with both drill and chisel. Drilling was previously considered more precise and reduced the risk of inadvertent injury to surrounding structures, whereas chiselling cleaves along natural planes in the bone. Chiselling also avoids the risks of tinnitus and sensorineural hearing loss, which can be associated with the direct transmission of sound energy to the inner ear through the canal wall when drilling.
Traditionally, exostosis surgery has been performed via a postauricular technique with a cut behind the ear crease.
Current Practices
I have moved towards endoscopic exostosis surgery using a saline chilled endoscope and micro chisels custom-made for transcanal ear surgery. We also have been using piezo surgery to assist us in the surgery. Piezo surgery uses ultrasonic vibrations in disposable surgical tips to remove bone and not damaging soft structures such as skin and cartilage.
Using these transcanal techniques, you can have surgery the same day and just leave hospital with a piece of cotton wool in your ear canal as the only dressing. Healing is faster if we can preserve more skin and we have got some surfer’s back in the water only 3 weeks after surgery.
Because of the side effects of traditional postauricular surgery, the general advice has been not to have exostosis surgery until the exostosis were causing severe obstruction. Now that we can perform surgery safely and efficiently endoscopically down the ear canal, my advice is to consider a surgical opinion as soon as retained water after surfing et cetera is becoming an ongoing nuisance.
We can assess the size of your exostosis and determine whether you would be suitable for a day surgery transcanal micro chisel exostectomy. If your GP has a video otoscope, then send us a picture.
