Say What Part 2—Ear surgery field notes

 If you kayak, and the water you kayak in is below 68 degrees, you will most likely eventually need surgery for surfer’s ear.   I was fortunate enough to book room number 2 at the Santa Cruz Surgery Center last week to get my left ear chiseled open by the world famous surfer’s ear doctor, Dr. Douglas Hetzler.
 
The following are some tips and musings on how to get the most out of surgery, in no particular order of importance or relevance.
 
First, get insurance.  Good insurance.  Nothing about surgery is cheap and if you don’t have insurance, or if you have inadequate insurance, you might be less likely to get a good surgeon or even get surgery done at all.
 
Second, don’t procrastinate.  Like most people, I nursed my closing ear canals as long as possible delaying the inevitable.  This is stupid on several levels.  First, I put off using earplugs for way too long.  Second, I ignored the warning signs of impending doom by just “dealing with it” while not really DEALING with it.  If you have difficulty draining your ears after kayaking, get infections, have hearing loss, if wax tends to always clog your ears or something just doesn’t seem right in your ear, you are in denial and the longer you refuse to acknowledge the problem, the worse it will become.   
 
This past May my long free ride came to a fairly dramatic end with multiple trips to a local ENT, four cortisone drop courses, micro suctioning four times, oral antibiotics, and total closure for 3 weeks when the swelling got so bad that it totally blocked what little opening I had in the first place.  I heard nothing out of my ear for these three weeks and totally freaked out.
 
I found an excellent ENT an hour away that used the drilling method for surgery which involves making small cuts inside the ear canal to access the bone, pushing the skin to the side, and then drilling out the excess bone growth with progressively finer drills until a clear canal is present.  I was so anxious to get back my hearing that I scheduled surgery for 2 weeks away.
 
At home, I began in earnest the research that I should have done years ago.  Asking friends opinions about procedures, getting recommendations for surgeons, doing a poll of my Social Media friends, watching You-Tube videos of the different types of surgery, etc.
 
A clear direction began to emerge and it strongly favored getting the surgery done in Santa Cruz by Dr. Hetzler.  One friend was so insistent that I pick Dr Hetzler and gave such compelling arguments against drilling that getting my ear chiseled instead of drilled became a no brainer decision for me.  Hetzler is in the minority in terms of the type of surgical procedure he does in that he painstakingly uses a 1 mm (.04 inch) chisel to shave down the bone growth layer by layer instead of a drill and it didn’t take me long to figure out that he is the grand master of this technique.
 
The advantages of chiseling were very evident once I started asking questions and talking to people on both sides of the drill vs. chisel experience.  There is no heat damage to the skin like there can be with a high speed drill which can potentially generate significant heat.  There is no negative impact on hearing using a chisel since it eliminates the high decibel drill noise and whine from the equation.  You are less likely to develop tinnitus.  The delicate ear skin, which is the thinnest skin on the body with no layer of fat for cushion, is not torn or shredded like it potentially can be by the drill.  Because of the less invasive nature of using a chisel, the healing time on average is dramatically less than with a drill since there is less overall tissue damage to the canal during the process.  You can also get both ears done at once which is huge if you need both ears worked on, and most kayakers do.  
 
My ear was 97% blocked, way past when I should have dealt with it, and the operation took around 2.5 hours where the usual is 1.5-2 hours.  There was surprisingly minimal pain after the surgery and I never used any medication or felt the need to at any time.  After the surgery no packing is used; the canal is covered in an antibiotic ointment and a cotton ball sits in the outer ear to absorb any drainage.  My ear was partially clogged and hearing was muffled until the first post-op visit 6 days after the surgery, but all things considered there was a very minor impact to my lifestyle.  I had very little drainage and ditched the cotton ball after a couple of days.   The main issue I had was with the anesthesia and the subsequent hangover and general feeling of malaise for days after the surgery but that is a personal reaction on my part and doesn’t necessarily translate to others experience.  After the first week and the cleaning out of dried blood and residual liquid from my ear I felt 100% back to normal and was able to resume all physical activity and sports aside from boating.
 
The followup on day 6 included gently removing some of the secretion and blood clots.  It felt wonderful to be able to hear normally again and discover how quickly my ear was healing.  A final visit was scheduled for 2 weeks after this when the last of the dry skin was removed and I was cleared to get back to kayaking for a total time off the water of just 21 days.  
 
Take aways:
 
Plan ahead.  Not like anyone is ever going to do this, but at least have a surgeon or a good ENT that you have lined up in your queue.
 
Whether you chose drilling or chiseling, pick a surgeon that has done a lot of ear plasty surgery.  Dr. Hetzler has done over 2,300 ears.  You are not going to find anyone with those stats, but I would insist on someone with more than say, 20, under their belt.  Like anything, practice makes perfect, and it’s your ears and lifestyle we are talking about.
 
I highly recommend doing a road trip to Santa Cruz to have Dr. Hetzler do your surgery!  He allows you to show up the day before the surgery for any pre-op work needed, have the surgery done the next day, and either leave and have follow ups done at home, or stay a week and have him do the post-op.  You will only feel spacey for maybe a day after surgery so you will still be able to enjoy the week and do things—and there is a lot to see and do in Santa Cruz.  It doesn’t get any easier than this to have the best do your surgery.  He told me he usually does 4 operations a week and is currently booked out 2 plus months so keep that in mind when you plan your trip—or ear problems.
 
Preemptively, book a visit with a well recommended ENT to monitor where your ears are now in terms of closure as a baseline and depending on the level of blockage, go from there regarding the level of future monitoring.   Do this relatively early in your kayaking career.  
 
Wear ear plugs.  This is the simplest and cheapest route to either prevent or delay the necessity of surgery.  If you hate wearing ear plugs (and who doesn’t), wear them at the very least when you play boat—that is the time you are most likely to be repeatedly immersed in cold water.  Wear them in the winter only when temps tend to be lower.  Find a time to wear them that works for you if you can’t wear them every time you boat.  The more you wear them, the more pro-active you are being about your ears.  I use SURF EARS plugs and they work well for me with little or no negative traits that would keep me from wanting to wear them.
 
I was a little skeptical of all of the over the top platitudes that my friends heaped on Dr Hetzler but I am now a card carrying member of the Hetzler fan club.  He is personable, warm, sincere, and dedicated to what he does.  When I first sent in a request form I got off the internet, he personally answered the next day and took the time to make sure I understood what he did and how to book an appointment quickly.  He will spend all the time you need during appointments to answer any questions or concerns that you have and you will come away feeling good about having surgery.  It is rare these days to find someone so genuine and dedicated to helping people and it is refreshing.  Dr Hetzler and his assistant Donna are a combination that is hard to find in the medical world and I am eternally grateful to have been lucky enough to have the surgery done by him.  
 
Some links:
Dr Hetzler: https://www.sutterhealth.org/find-doctor/dr-douglas-hetzler
 
Link to an interview with Dr. Hetzler: http://www.thesurfchannel.com/news/20140429/how-to-treat-surfers-ear-with-doctor-hetzler/
 
A video of surgery done with chisels (graphic): http://www.pamf.org/ENT/services/surfersear.html
 
Link to Surf Ears ear plugs: https://surfears.com
 
If anyone has questions about this surgery, feel free to message me or comment below.  The take-away for me is that surgery is really not that big of a deal given all of the drama and hype that I had heard and read about.  Finding Dr Hetzler and having him do the surgery was a huge part of that and my advice to paddlers with surfer’s ear if you can’t get to Dr Hetzler is to find an ENT surgeon who has a lot of experience with ears and uses the chisel method exclusively. 
 
Happy Paddling,
Hilde

Comments on “Say What Part 2—Ear surgery field notes”

  1. Mark Westerkamp
    December 4, 2018 at 2:02 pm

    Great advice ,you are so lucky to have Dr Hetzler,I am in New Zealand and can’t find any specialists who use the chisel method ,both my ears need doing and I’m not looking forward to the drawn out process of one at a time with all the additional risks that drilling entails.

  2. Tony Lunt
    December 7, 2018 at 3:24 pm

    That stuff they got out of your ears look like Grand Canyon gravel…

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