This is not medical advice - I am not a doctor (I studied fish). 

I am also not earning anything from this article. 

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Cape town, South Africa - July 2023

Bilateral Exostoses (Surfer’s Ear) - the Chisel Method.

Take Home: I’d do it again.

The details.

I am quite familiar with Ear Nose and Throat specialists, thanks to my lifelong relationship with hay-fever. Its always the same: avoid dust, pollen, smoke, cats. Use a cortisone spray daily, get a new vacuum… I’ve mostly ignored that advice.

Im also fortunate to have been submerged in an ocean, almost daily, for the last 14 years. Im a marine biologist, happiest living by the tides. And the wind. There’s a lot of wind in Cape Town.
Sun protection is a must, ear protection is a somewhat newer concept.

Exostoses are multiple, benign bony growths within the external auditory canal in response to repeated exposure to cold water. Basically, your ear canal closes over time, assumedly to stop cold water from reaching your ear drum. These growths can be removed surgically by chisel, drill or ultrasonic blade.

Why did I have the op?

I was plagued by constant bouts of painful ears, minor infections - general discomfort. Made worse each time I got into the ocean. I could not find any ear plugs that worked, and diving was almost not an option anymore.

I was nervous to surf bigger waves, to dive and photograph Cape Town’s remarkable kelp forests. I avoided wetting my ears in the shower. My enthusiasm to get into the water was curbed by my nervousness of getting my ears wet.

One particularly bad infection lead me to an ENT who confirmed the exostoses. Lets call it 80 & 85% closed on the left & right ears respectively (its hard to tell exactly as your ear canal is bendy).

The arrival of our newborn baby girl (Charlie Grace) meant that I needed to be home for a while. 

I got sign off from my wife and pulled the trigger.

The build up.

I visited 3 Ear, Nose & Throat specialists for this particular case, sort of by mistake.

The first seemed a little too self-assured and was vague about which method they’d use. I also wasn’t sure what to ask. But they did show me my ear canal with a nifty usb mini-camera - available online apparently. I also learnt that ear canals are not pretty.

The Second ENT has stopped using the Rotary Drill Method as there is concern over the high-pitched sound of a drill damaging one’s eardrum. The Rotary drill is more of a cutter than a drill. They also only operated on one ear at a time which would mean 2 x hospital visits, 2 x doses of general anaesthetic and 6 months out of the water.

They referred me to Dr Gary Kroukamp who specialises in The Chisel Method.

The coffee table in Dr Gary Kroukamp’s waiting room is an old, solid, door with a solid glass top. Its quite beautiful, but also “incredibly heavy" according to his secretary.

He ushers me into his office and takes a look in my ears, confirming what I already knew: ‘its time for the op’.

I was concerned that my ears may have received more abuse than most, he nodded but did not seem phased. He suggested we do both ears at the same time, next week. “You’ll be home the same day, and back in the water in 2 weeks”. TWO WEEKS!? Hmm.. too good to be true?

The procedure - The Chisel Method

Dr Kroukamp accesses the offending bone(s) with 2 types of chisels, pictured below. They’re actually quite beautiful, razor sharp, heavy in your hand. Chisels mean that there is no need to ‘butterfly’ your ear open to gain access, as per other methods. He goes in down your existing ear canal, hence the speedy recovery.

Compared to drilling, the chisel method seems a no brainer. It requires light tapping to chip away what is actually a tiny bump of bone. Plus, not requiring surgery to open up and access the ear canal means a less invasive procedure.

I was concerned to learn that its apparently quite normal for ear drums to be nicked during the surgery - about 1-in-10. But a clean slice from a chisel is often less damaging than a drill, that could rip the eardrum, normally healing within 2 weeks, so I’m told.

How much did it cost?

Total cost: R44,714.00

This procedure can be done at a regular hospital or a day hospital / clinic, each with their own rates. I had my operation at Harbor bay day clinic in Simonstown, Cape Town - it was cheaper than going to a ‘regular’ hospital.

Check with your doctor, medical aid and/or gap cover.

Breakdown:
Initial consult (cash):

• Dr Kroukamp, ENT: R1,400.00

Surgery (covered by Discovery Health Coastal Core Medical Scheme, I did not need to claim from my Gap cover):

• The anaesthetist: R9,253.00 ZAR

• Dr Kroukamp - Ear Nose & Throat surgeon: R12,184.00 ZAR

• Harbour Bay day clinic: R21,876.00* ZAR

  *Medical Aid did not pay R1.27 of this.

The Day of:

“You look ready to run”

“I am”

“Ok, let’s play a game - we’ll give you some of this stuff (anaesthetic) and see how far you get”…

(I was taken home by my wife 6 hours later.)

I really dislike hospitals - its not my natural habitat. I was nervous. I arrived at the day clinic at 7am, first in line, was checked in and waited. I could have run a mile. I was wheeled in to theatre at 8am and finished up at 10:30am (apparently).

At 1:30pm I awoke, groggy, reeling. I would not have been capable of driving home. I was given instruction to keep my ears dry until the checkup a week or so later, to change the cotton wool daily and call if I had any questions.

I was shuffled to the car, driven home, taken inside and fell asleep for the afternoon. I woke for dinner, took a painkiller, and slept the rest of the night. That night my ears bled on my pillow (hint: cover your pillow with a towel for a few days).

Day 2: I woke up late expecting sharp pain in both ears but was surprised how little pain I felt. Everything was muffled due to the pack* and cotton wool in each ear. I was OK! No dizziness, nausea or (serious) pain.

*Both ears were packed with some kind of ‘pressure pack’ to aid healing. Charlie’s 1month old cries were muffled for 2 weeks, but I had no bandages, stitches, or serious pain. Having to sleep on my back for 2 weeks was the biggest physical inconvenience.

2 days later: Sounds continue to be muffled, especially when multiple people talk at once. The odd occasional short, sharp, jolt of pain. I was still surprised by how little pain I felt, and almost no bleeding. Is it still coming?
I did take over-the-counter pain killers twice in the week following the procedure, I could have gone without.

1 week later: The follow-up appointment. Dr Kroukamp took out the pack, painlessly. There was much less ‘stuff’ in there than it felt like. I was expecting a thumb size pack of cotton wool - it looked more like tiny bits of washed up beach plastic. I was sent on my way with 5 days of antibiotic drops to be used twice a day. Call or whatsapp if I have any questions.

I felt pretty near recovered at this stage - no pain or bleeding, no anaesthetic aftereffects, and a week of rest and healthy living.

2 weeks later: A 10minute checkup, with a tympanometer to check my ear drum integrity and sign off that Dr Kroukamp was happy with the recovery - I could now get my ears wet.

3 weeks later: I went snorkelling! Ok, so I did wait an extra week, just to be sure. It felt a little strange getting water in my ears for the first time in more than a year, but there were no hassles - it was fantastic. I do now dive with sticky tack in both ears, having perfected the art of sculpting an ear shaped, purge-able, plug.

The following day I surfed one of my favourite waves, and was barrelled on my last wave. When enthusiasm outweighs skill I believe this a rare sign of more productive ocean adventures to come, and a job well done. Lucky fish.

Thank you Dr Gary Kroukamp for renewing my underwater enthusiasm.

See you on the water, or sign up to get more of this in my fortnightly email briefing.