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Photograph by Curtis Cartier

Surf Ear Safari

A Santa Cruz doctor has become a world expert at healing a notorious problem

By Jessica Lyons

BLAME JACK O'NEILL and his nifty 1952 neoprene invention.

"Jack O'Neill invented the wetsuit, people start spending more time in the cold water and that started the problem," says Dr. Douglas Hetzler, an ear, nose and throat specialist in Santa Cruz.

The problem is surfer's ear, or "exostosis of the external auditory canal," as otorhinolaryngologists call it, and it's caused by repeated exposure to cold water and wind. Essentially, the cold stimulates bone growth in the ear canal. This narrows the opening, trapping water, wax and dead skin in the canal, and blocks the eardrum, leading to painful infections and hearing loss.

"Per capita, Santa Cruz has one of the highest rates of surfer's ear in the world," Hetzler says. "People surf year-round here."

And Hetzler has operated on hundreds of them. He pioneered a drill-less surgery for fixing surfer's ear a dozen years ago and has since treated some 800 ears. He's also one of just a handful California doctors who perform the minimally invasive procedure, which is why patients come from Long Island and beyond to have Hetzler chisel tiny pieces of bone out of their ears, and why he gives presentations on the technique in Mexico, Australia and Ireland. Recently, a surgeon from Bordeaux, France, came to observe Hetzler's magic, well-manicured hands at work.

Hetzler himself has only surfed four times and only in Hawaii. He has "a severe aversion to immersing body parts in cold water," although he does compete in triathlons, some of which require swimming in the Monterey and San Francisco bays. But he's never seen an ear he couldn't operate on.

He shows a video of a 30-year-old with an obliterated ear canal—it's 100 percent closed, and you can't see any part of his eardrum. Then Hetzler starts tap-tap-tapping with tiny, custom-made 1 mm chisels (Hetzler worked with instrument manufacturer Bausch & Lomb Storz to design various shapes), to break off the excess bone growth.

Bone grows in layers, like an onion, so it's easily cleaved by chisels. In the video he eventually pulls three pieces of bone out of the ear canal, which he will put in a plastic container and send home with the surfer.

"He was back in the water after three weeks," Hetzler says, adding that the recovery time is typical.

The speedy healing and return to the water is one of the advantages of Hetzler's procedure compared to the way most surgeons treat surfer's ear, which sounds akin to medieval torture: A surgeon makes an incision behind the ear, peels back the ear, skin, muscle and cartilage, then uses a drill to remove the bone from the ear canal.

"Traditionally, in the surfing community, this surgery has a horrible reputation," Hetzler says. "It's painful, it takes two to three months to heal." And the drill itself, which may expose patients to up to 130 decibels of sound, can cause hearing loss. The drill, in fact, is what got Hetzler thinking about using chisels in the first place. "If we're supposed to be the guardians of the ear, why do we want to inflict that much damage?

"Now, if someone said they'd take my chisels away, I wouldn't do the surgery."

Ear surgeons have performed surfer's ear surgery since the 1870s using a drill—although they didn't know what caused the problem. Syphilis, alcoholism and gout were a few commonly suspected culprits.

Anthropologists, too, have studied the condition—it was even discovered in a 9,000-year-old skull—and it's been found around the world, including in inland areas where people hunt for fish by immersing themselves in water.

These days, Hetzler sees few hunters and gatherers and more surfers and kayakers. Gannon Myall's a surfer and professional cyclist who grew up on the beach and in the water.

"My left ear, the problem ear, it tended to get infected," Myall says. "I also race bikes professionally, in the snow, in the cold. Cold water, cold wind—it was a double whammy for me."

Hetzler operated on Myall's left ear June 4. Two weeks later, he gave Myall the OK to surf again.

Ryan Woodhouse, who once went four weeks with no hearing in his left year, just had his three-week post-op checkup, at which time Hetzler cleared him to get back in the water. "It's a pretty easy recovery," Woodhouse says.

"I was back to work with fairly limited hearing after three days." Now that Hetzler's given him the green light to surf, he's planning on wasting no time. "I'll be right in at the next opportunity," he says. "Not tonight, but possibly tomorrow morning."

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