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Otitis Externa

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Dear Doctor, I have been diving for almost 10 years and surfing for about 15. I have always had a problem with water in my ears. It is particularly a problem when I am diving and I invert my head. This causes a sound and I can feel the water go deep into my ears. I am to the point where I use an ear drying aid, (Swim Ear)after every ocean visit. In addition I sometimes use ear plugs while surfing. I feel like I have permanent water in my middle ears. It is particularly noticable in the morning when I wake up. It is also noticable every time I hiccup, it makes a distinguishable sound. On occasion I also have a slight ringing in my ears. Is this a common occurrence? Can it be cured? Any info would help.

Hello: Hope I can help you! First--there's no way you can get water in your middle ear without holes in your eardrums! If that were the case you would have other more severe symptoms, such as dizziness, loss of hearing and pain. Second, what you are describing is a common complaint of swimmers who go under water briefly and get water trapped in the ear canal, either by an anatomic variant or ear wax. I suspect that your problem is ear wax that's been pushed in and packed close to the ear drum, trapping water. If you haven't been to an ENT doctor--you should have them checked and cleared of any blockage. The noise that you hear with hiccuping is dur to closure of the ostia of the Eustachian tube.

Here's a trick I learned from Dr. Fred Pullen --if you have water in the ear, and can't get it out--cup a handful of water over the ear and pull it away suddenly, the surface tension of the water in your hand will pull the inner water out!

The ringing in the ear is sometimes more ominous--you should have your ears checked for possible inner ear damage sometimes in the past.

My recommendation--stop using ear plugs.


Dear Doctor, My 18 year-old son is being treated for External Otitis with an antibiotic. I understand that ear care is an important part of after treatment, but I've forgotten the ingredients for the solution we divers use in our ears after swimming or diving. I have some made but it's old. Can you help?

Hello:

The solution you need to make up to prevent further recurrences can be made by adding 1/3 white vinegar to 2/3 isopropyl alcohol. A few drops in each ear after diving will help evaporate the water--which sets the stage for the bacteria and fungi. The alcohol can be somewhat irritating, so you might want to substitute hydrogrn peroxide or use an acetic acid-aluminum/sodium acetate solution. See below.

Be sure your son continues his treatment for 10 full days, regardless of whether or not he feels well.

*There's also a generic form of 2% acetic acid in aqueous aluminum acetate otic solution that is similar to Domeboro Otic, which is not made by Bayer any more. This is nonirritating and effective, and the treatment of choice by every ENT I've heard or read who is also an active diver .



Eardrops

Methods for making up Preventative Ear Drops and Instructions for use. Please take to your Local Pharmacist. 


Aluminium Acetate Ear Drops 8%

8 parts of Aluminium Acetate solution BP with 5 parts purified water, freshly boiled and cooled.

Instructions for use

2 to 3 drops should be applied to both ears once a day. If the water you are diving in is contaminated in any way then use the drops before and after diving.

The shelf life of the bottles once opened will be one week. 



Non aqueous Solution
2% Acetic Acid, in a propylene glycol vehicle containing Propylene glycol Diacetate
3% and Sodium Acetate 0.015%.

Instructions for use

2 to 3 drops should be applied to both ears once a day. If the water you are diving in is contaminated in any way then use the drops before and after diving.

The shelf life of the bottles once opened will be one week. 



Technique for use
The head should be tilted to one side and 2-3 drops allowed to fall into the ear canal. The dropper must not touch the ear or anything else. The head should then be kept in this position for about 5 seconds whilst the tragus  ( the cartilaginous lump in front of the external ear orifice ) is gently massaged in a circular motion.



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 Ernest Campbell, MD, FACS All Rights Reserved.


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