Ear care (otology)

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Surfer's ear is basically a condition
where you experience bone growths in the ear canal.
And as those bone growths enlarge and narrow
the ear canal, people can experience
water trapping, infections, hearing loss.
And the reason it's been called surfer's ear
is because the surfing population
seems to have it at a very, very high proportion.
In fact, when Jack O'Neill invented the wetsuit.
He really set this off.
Because part of that-- people weren't
spending a lot of time in cold water.
Per capita, we have one of the highest
rates in the world in this area.
If we wanted to make this happen in somebody,
we would just repeatedly dip them in and out of cold water.
And the nature of the sport of surfing
is that's exactly what that involves.
The techniques I was using to address it
initially were those that I was taught in residency
and learned from textbooks of ear surgery.
And those typically involve using a drill in some fashion.
My original motivation was concern
about the noise of the drill, which in some cases
had been measured up to 130 decibels.
And that's where I thought the chisel technique would
be so effective.
But what I also found was it was far easier to protect the skin
once you knew the technique.
And people healed faster and they
experienced less post-operative pain.
So there were a number of factors
that made it real advantageous for the patient.
But from a surgeon's standpoint, knowing what I know now,
if someone took my chisels away and said I had to drill,
I wouldn't do the operation.
Some of these guys seem to be able to fill up their whole ear
canal with bone.
The biggest single piece I ever took out
was about the size of the tip of my little finger.
I think we're up to about 1,307 ears.
And that's roughly 747 patients.
And those patients have come from 25 states in the United
States, eight foreign countries.
I've had email inquiries from really all over the world.
There was a surgeon that came from Miyazaki, Japan
earlier this year to see me do it.
There was something that came from Bordeaux, France
a couple of years ago to learn the technique.
So it's gradually finding its way
into further and further parts of the world.
But it's not as readily available outside of this area.
So patients are still willing to travel to have this done.
We basically started from scratch
in terms of trying to figure out OK,
what instruments are going to let us do this operation?
And every step of the way is there
something that could be done better?
There are a number of prototypes that
had to be modified in a variety of ways,
redesigning our instruments and modifying instruments
to work better in the operating room.
Worked with the Bausch & Lomb Storz medtronic company,
Karl Storz USA at developing some of these things.
So we worked with prototypes and modifications
of those prototypes to get it to where it is today.

There's no moral ambiguity about this operation.
There's certain things where you can say, OK,
we may try to do something for someone.
Are we really accomplishing something?
Did they get better on their own or is our intervention
making a difference?
In these it's a very, very tangible thing
for me and the patient.
We can see what the problem is.
We can see the obstruction.
You can see why they're having problems.
I'm somewhat of an athlete myself,
although not really a surfer.
But I know what it's like to be on the sidelines
and be sidelined from something you really love to do.
So to help these people get back to what they love doing
has been very gratifying.
A number of years ago one of my patients
was quoted in a local newspaper as calling me
the Michelangelo of ear surgery, which
I guess I consider a very favorable comparison-- using
chisels but I've not created any tremendous works of art,
other some good looking ear canals.
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