We have a number of Aural Care Nurses who look after patients with both chronic and acute ear conditions. We work closely with the Consultant ENT surgeons, and the Audiology department to provide initial treatment and continuing management.

The department is based in the ENT department at the Royal Cornwall Hospital. We also hold clinics at Bodmin Hospital, Camborne/Redruth Hospital, Newquay Hospital, Penrice Hospital, St Michaels Hospital and West Cornwall Hospital.

Referrals to Aural Care

We accept initial referrals from GP’s, practice nurses and from other departments from within the trust. Please send all referral letters to:

The booking team
Head and neck
c/o Pendragon house
Royal Cornwall Hospital.

To discuss a new referral, GPs and healthcare professionals can also call 01872 252272

If you need inpatient treatment or surgery, you’ll stay on Wheal Coates ward, which is a dedicated head and neck ward. Children have their own, separate and dedicated surgical ward named Harlyn, which is next to the adult ward. We have a separate Day Surgery unit, although you may also be a day patient on one of our specialist wards.

We run specialist clinics at the Royal Cornwall Hospital in Truro for children’s hearing disorders, neck lumps, thyroid, specialist cancer, two-week wait referrals and an early post-treatment clinic for patients who have received radiotherapy.

Nurse-led rhinology and aural care clinics run weekly throughout the county at Royal Cornwall Hospital, St. Michael’s Hospital, Camborne and Redruth Hospital, Falmouth Hospital, Newquay Hospital, Bodmin Hospital and Penrice Hospital.

Speciality Lead

Mr Phil Flanagan

Associate Specialists

Dr Duried Rifai
Mr Kel Anyamwu

Staff Grade Nurses

Mr Thaung Naing
Miss Joythi Strinivassan

Clinical Nurse Specialist

Miss Eirian Jones
01872 252423

Head and Neck Cancer Specialist Nurse

Miss Jacqui Williams
01872 253475

ENT Outpatients

01872 254901

We are a teaching team

Ongoing training and professional development is integrated with the work of the ENT department. We work with a number of 3rd to 5th year undergraduate medical students from the Peninsula College of Medicine for their pathway weeks, placements and Specific Study Units. We also host surgical trainees and run Weekly Foundation and Core Trainee training programs.

Surfer’s ear (or auditory exostosis) is the narrowing of the ear canal due to abnormal formation of boney growths protruding into the ear (fig 1).

What causes it?

Repeatedly exposing your ears to cold water over an extended period of time. UK surfers are particularly at risk due to year round cold water exposure.

UK water temperatures can range from as low as 5­6 oC in the winter to 15­16 oC in the summer. These temperatures combined with wind chill are the major factor in the development of surfers’ ear.

It is thought that cold water entering the ears produces an increased blood flow which stimulates the bone formation. Evidence suggests exostoses can develop in as little as 5 years of regular cold water surfing if your ears are unprotected.

Narrowing of the ear canal may result in:

Blockage & difficulty clearing ears of water, wax and debris

• Recurrent ear infection
• Decreased hearing or deafness

What to look out for:

• Ear pain, itchy ears, discharge or recurrent infection
• Difficulty clearing water from ears or a plugging sensation
• Problems with hearing loss

Prevention is better than cure

Keep cold water out your ears. This is achievable with ear plugs and/or wearing a hood particularly during winter months.

Ear plugs

Ear protection can range from non­customised over the counter ear plugs, of which there are plenty on the market, to custom made ear plugs which can either be arranged through your local health services or privately. Many surfers advocate using blue tac, and find this gives a

comfortable tight seal if applied correctly (fig 2). There is good evidence to suggest that using ear protection will significantly lower your chances of developing exostoses.

Conservative management

If you are suffering symptoms related to surfers’ ear they may be managed with conservatively by your GP who may prescribe antibiotic ear drops if there is concern about infection.

If you are concerned that you may already be suffering from surfer’s ear please contact your GP

Surgical removal of exostoses

If conservative management fails and symptoms become frequent, surgery may be appropriate. Removal of exostoses is undertaken by ENT surgeons. Nowadays the operation is usually carried out as a day case, under general anaesthetic, so you will be asleep during the operation.

Procedure

The operation takes approximately 60­90 minutes. An incision can be made at the front of the ear (endaural) or at the back (post auricular) to provide better access to the ear canal.

Under microscope the surgeon will expose the exostoses in the canal and remove the exostoses either with a miniature drill or a micro­chisel. Sometimes, particularly if there are exostoses close to the ear drum, both the drill and microchisel will be used in combination.

Following successful removal of exostoses, the ear is packed and dressed and the incision closed with sutures. This area heals well usually with minimal scarring. The pack remains in the ear for 2 weeks.

Recovery

It will take several weeks for the ear canal to heal. It is important during this time to keep the ear as dry as possible. You are likely to have to stop surfing for a minimum of 6 weeks. Time out the water is dictated by how quickly your ear canal heals.

Risks of surgery

Complications with this procedure are minimal and it is generally considered safe and straight forward operation, however, surgery always carries risks and your consultant would discuss these with you.

Public perception

Patients often have a high degree of anxiety regarding operations on ears. For this condition however we have found that there are a significant number patients returning to undergo the same surgery on their other ear. This is testament to the straight forward and tolerable

nature of the operation. In our experience we find patients who have undergone the procedure to be highly satisfied with results and improved quality of life.

Prevention is better than cure – PROTECT YOUR EARS

Author: Ewen Cowan (medical student)
University of Aberdeen
E­mail: ewen.cowan@NHS.net

Mr Flanagan consultant ENT surgeon (FRCS, ORL)
Department of ENT
Royal Cornwall Hospital, Truro