PAMF Health Blog

Be Well, Be Well Informed

PAMF Doctor Pioneers, Perfects World Famous Fix for “Surfer’s Ear”

Posted on Nov 11, 2011

“I leave the waves to my patients,” said Douglas Hetzler, M.D., FACS, an ear, nose and throat specialist at Palo Alto Medical Foundation Santa Cruz. But while surfing holds no allure for him personally, Dr. Hetzler, whose peers have dubbed him “Michelangelo of the Ear Canal,” has spent years perfecting a surgical technique to treat “surfer’s ear”-a serious auditory condition that robs surfers and kayakers of their hearing and, eventually, their sport.

Surfer’s ear is caused by repeated exposure to cold water and wind. This is because the skin of the inner ear canal is paper thin and there is no insulating layer between this layer and a deeper layer that stimulates new bone growth. After thousands of hours of exposure to water colder than 68┬║ F, usually without ear plugs or a neoprene hood, bone growth may occur, significantly narrowing the ear canal, trapping water inside, and resulting in painful infections and hearing loss.

The highest per capita rate of surfer’s ear in the world is found in Santa Cruz due to the cold ocean water, year-round great surfing conditions and the large number of surfers who have been catching waves here for decades.

Enter Iowa-born Dr. Hetzler, who came to California to complete his residency training in otolaryngology with Kaiser-Permanente in Oakland. Soon after, in 1988, he began practicing with the Santa Cruz Medical Clinic, now part of the Palo Alto Medical Foundation.

“Traditionally, ear surgeons removed surfer’s ear using a drill,” said Dr. Hetzler. “But drilling in the ear can expose the person to up to 130 decibels, as well as tear up the skin of the ear canal, which complicates the healing process.

“My patients were already coming to me with hearing injuries,” he continued. “So why risk inflicting noise injury, too?” So in 1998, Dr. Hetzler began working on a technique that would allow him to perform the entire operation using delicate, highly precise chisels. To perfect the procedure, he worked with a company in St. Louis to create his own specialized tools.

Today, 532 patients and 915 ears later, Dr. Hetzler is one of only a handful of California physicians to use this minimally invasive technique, which can restore hearing and usually allow surfers to get back in the water in about a month.

While many of his patients are from the Santa Cruz community, Dr. Hetzler has performed this procedure on people from 18 different states, ranging in age from 17 to 84. “We’ve seen surfers from Michigan, Maine and New Hampshire,” he said, “and kayakers from mountain regions in Utah, Colorado, the Carolinas and Tennessee.”

Other surgeons have come from as far as Bordeaux, France to observe Dr. Hetzler’s procedure. He also gives lectures to professionals in his specialty at Stanford, UCSF, at national meetings and international meetings in Australia, Mexico and Ireland.

“Some of the surfers who come to us are on the verge of giving up the sport they love so much,” Dr. Hetzler continued. “So they’re thrilled to find out we can help them. They’re the happiest people you’ve ever seen who are going into surgery.”

Dr. Hetzler recalls one surfer in his 40s whose surfer’s ear had caused a 70-decibel hearing loss, making him nearly deaf. “He was becoming somewhat anti-social because people around him always had to yell at him,” said Dr. Hetzler. In one 90-minute, outpatient procedure, Dr. Hetzler was able to restore the man’s normal hearing. “Suddenly it was a noisy world he had to get used to-a world that included surfing once more. He was ecstatic.”