【for Surfers overseas】surgery in Japan [Medical Tourism]

Surfer’s ear

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.

Surfer's Ear is formally known as exostoses.

The ear canal consists of a cartilaginous part and a bony part.


The bony prominence which occurs at the bony part of the external ear canal is known as exostoses.




In the  early stages there are seldom any symptoms.

Difficulty to drain water is a common symptom of surfer's ear.

Based on my epidemiological study, usually this symptom gets worse when the ear canal has narrowed to about 50% obstruction.

Tinnitus and itching of the ear may also occur.

And in severe cases, hearing loss or repetitive inflammation accompanied with earache may occur.

Hearing loss is not an accompanying symptom even in severe cases unless it is associated with acute inflammation of the external ear canal.

Do you need Surgery?

Usually, asymptomatic surfer’s ear lesion is no indication of surgery.

In my opinion, surgery is required in cases where repetitive external ear canal inflammation, difficulty in removing ear wax, and hearing loss due to ear wax accumulation, occur.

Free Surfer's ear check up in Surfshop :Boardroom, Perth. AUS 2019

How to remove bony lesion.

Chisel (Osteotome) technique for surfer's ear surgery was introduced by Dr.Douglas G. Hetzler in 2007.

In comparison with drilling techniques, the chisel  technique for removal of ear canal exostoses has a number of advantages.

Unlike a drill burr, chisels pose little risk of damaging skin and can be used adjacent to and under intact skin.

It enables surgeons to preserve the ear canal skin more.

There is the potential advantage of less risk of cochlear (inner ear) damage when using chisels to cleave bone compared with the noise generated by drilling in the ear canals of patients with normal hearing.

External ear canal skin has a very important function; a self-cleaning function. That's why ear wax doesn't accumulate on the ear drum and in the deep part of the external ear canal.

Therefore removing the bony lesion while preserving the ear canal skin is important.

Usually this operation is undergone with general anesthesia, because the operation is unpleasant for patients, and the time is rather long.

Usually, it takes about 60 - 90 min per ear to operate, depending on the degree of obstruction and the location of surfer's ear.

Usually, I allow patients to start surfing  2 or 4 weeks after the operation.

Possible complications

Of course we always pay attention to prevent possible complications as below.

Damaged ear canal skin

mastoid air cell opening

perforation of the ear drum

Facial nerve palsy due to drilling heat damage

sensorineural hearing loss due to drilling noise

vertigo and tinnitus

Surfer's Ear Treatment Tour in Japan

We can provide safe treatment for surfer's ear at Oiki Ear and Nose Clinic, Osaka, Japan.

We mainly use chisels for surfer's ear surgery to avoid sensory neural hearing loss due to drilling noise.


Moreover, chisel technique is a better procedure to preserve the skin of the ear canal so it leads to an earlier recovery.

We always try to discuss and confirm the diagnosis and pre-post operative treatment (including pre-operative examinations) for your ear with your doctor (ENT specialist in your home country) before you come to Japan.

Recommended Route

Saturday or Sunday:

Please Come to Osaka (Japan) and check-in to your accommodation. We can recommend a good guesthouse facing a big shopping mall.(below) You can go shopping and hung out before the operation.

Preoperative examinations for general anesthesia should be done in your hometown before come to Japan.

( a blood test, urine test, electrocardiogram, respiratory function test, chest X-ray and  photo  the ear canal if you possible.)

The cost of pre-operative exams are not included onsite treatment cost.


Admit yourself to Oiki Ear and Nose clinic at 9:00.

Surgery for Surfer's ear undergo with general anesthesia in the morning.

Preoperative examinations (CT scan of the ear and hearing test) may undergo before operation.

You can take a rest and stay one night in a private room after the operation.


Discharge from the hospital after the ear check up.

We recommend staying for several days (2~3days) after the operation for postoperative follow up and treatment.


Wednesday ~Saturday

Please don't do surfing if waves are excellent.

Instead, you can go sight seeing or hangout.

Remove all gauze and clean up  the ear canal at Haruka ENT clinic.

After all, we prepare a medical information document for your family doctor or ENT.

You can flying back to your home.

How much?  5500USD (all included as below)


1.Coordination of pre-operation (Online scheduling of the surgery, Judgement of surgical indication, Evaluation of the pre-operative examinations, making documents for surgery, Online post operative support)

Payment methods ( PayPal)

Please send  E mail beforehand (n.rider@hotmail.co.jp)
or DM from instagram @earsurgery.surf


YEN ¥550000

2.Onsite cost of surfer's ear operation is about YEN55000 for both ears.  (depends on exchange rate)

Payment methods (credit card: on arrival)

This includes hospitalization (one night stay)
pre - operative ear examinations (CT scan, hearing test, endoscopy of the ear canal), all meals and medications.

 If you have Japanese national health insurance the total cost is less than 1/3 of above.


Airfare​ and accommodation fees (Hotels) before and after surgery are not included.
Please book yourself.

Depending on your country, the total cost for surfer's ear treatment may cheaper than having it done in other country even after including travel expenses to Japan.


Closest Airport.

Kansai International Airport (KIX) located in the center of Kansai and Japan is an urban airport, offering a high level of convenience.

KIX provides access to 52 Asian cities, and has 17 international LCCs connecting it to 20 cities, the largest access among all the other domestic airports.(as of 2017 summer schedule)

Oiki Clinic and Haruka ENT clinic locate within one hour from KIX using train or bus.


Immigration Services Agency of Japan  [Entry from Overseas]


Before and After surgery, we recommend to stay this hotel nearby our clinics.

Hotel Route- Inn Osaka Izumi











How to Start

Free Online medical consultation with Dr.Haruka Nakanishi

Messenger (Facebook) : Haruka Nakanishi

Skype ID: haruent2000


Before coming Japan

For safe general anesthesia, we have to check the exams below within 1 month before operation in Japan.

Therefore, I would like you to be tested the exams list below once again for this operation.

These tests are standard for pre-operative exams.

Please show this list to your physician and ask him to check the result is OK for general anesthesia (usually about 3hrs).


ECG (Electrocardiogram)

Spirometry (if possible)

Blood type (ABO&RH)

Blood test (CBC with platelet, total protein, albumin, urinary acid, BUN, creatinine, NA, K, CL, T-cho, TG, T-Bil, GOT, GPT, ALP, γ-GTP, CHE, LDH, CPK, AMY, BloodSugar Coagulation test (PT, aPTT) Infection test (HBsAg, HCVab, TPHA)

Chest X ray-picture


Right before surgery: Covid19 PCR test  (send us the result within 1 week of the surgery)

Notice: The day before Surgery

For safety of general anesthesia these are most important informations.

Meals: You cannot eat any food after 0:00 of operation day.

Drink: You can drink water until 7:00 am of operation day.

If you have any medications, please take it at 7:00 am with small amount of water.

If you have bear, we ask you to shave it for safer surgery ( It is necessary for tracheal tube fixation during general anesthesia).


What to bring when admission

credit card


open front wear for operation room

one big towel

two small towels

drinks (We don’t have vending machines in our clinic, and you cannot go out until discharge. )

cup and tooth brush



Haruka Nakanishi MD, PhD  (www.surfersear.jp)

Medical education: University of Miyazaki

Department of Otolaryngology Head and Neck Surgery, Miyazaki University Hospital

2018~ Oiki Ear and Nose Surgi clinic

2020~ Haruka ENT Clinic director

Board certified Otolaryngology Head and Neck Surgery of The Oto-Rhino-Laryngological Society Japan
Board certified Japanese Society of anti-aging medicine

A Member of Surfer's Medical Association


Otology Society Japan Incentive Award 2009 for the article: Clinical Observation on so-called Secondary cholesteatoma. Otology Japan18(5):659-664, 2008

Poster Award 1st Place at the Triological Society Annual Meeting, CA, USA. 2012




With Dr. Douglas Hetzler July.2013
He is well known as the "Michelangelo of the ear canal" because  he introduced the chisel technique for Surfer's Ear surgery in this article:

Douglas G. Hetzler : Osteotome Technique for Removal of Symptomatic Ear Canal Exostoses: Laryngoscope 117:January 2007 Supplement

He has a lot of experience especially in surfer's ear surgery. I visited his clinic several times and received instruction about the chisel technique for surfer's ear surgery.

He is one of the best mentors of my life.

We have kept in touch and discuss development in the procedure of surfer's ear surgery.


Oiki Ear and Nose clinic

2-14-13 yayoi-cho, izumi-shi, Osaka, Japan
Tel (+81) 725-47-3113

It takes about 40min from Kansai Airport (KIX) airport by train and taxi or bus.









Facebook: Haruka Nakanishi

Skype: haruent2000

E-Mail: n.rider@hotmail.co.jp

Haruka Nakanishi MD, PhD
Haruka ENT clinic

594-0041  Izumichuo station 2F 5-5-1 Ibukino Izumi Osaka Japan.

Tel 0725-50-3333



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