This is an update to an earlier post. Click here to read the original post.
It has now been two full weeks since the infection started and my ear still will not equalize so I went back to the doctor today to have my ear checked again.
Apparently the Augmentin (Amoxicillin/clavulanic acid) antibiotics and the antibiotic ear drops that the doctor put me on two weeks ago did not clear up the infection in my ear. The infection in my ear canal has cleared up, but the infection in my middle and inner ear seems to be antibiotic-resistant. There is also fluid still being retained behind the membrane (ear drum), which they say may take weeks to dry up.
This is the second ear infection that I have had so far this year. Because of my past issues with ear infections, and my eustachian tubes being so tiny, they are referring me to an Ear, Nose & Throat specialist to have it checked. They also want to send me for a hearing test on that ear.
They are still worried about the possibility of there being a tiny hole in the membrane, but I don’t think there is because it is not draining fluid. It seems as if there were a hole there that it would drain and relieve the pressure behind it.
I will have to wait for the ENT specialist to call me to set up the appointments to find out what exactly is going on in there. So in the meantime they have put me on stronger intravenous antibiotics and I now have a portable pump that I wear in a shoulder pouch for the next ten days.
I hate getting IV’s. When I get my really bad migraines I have to get them for pain medication and hydration, now I have to wear one 24-hours a day for the next week and a half. This really sucks. I will see how it goes, you know they say that medics and doctors are the worst possible patients.
It’s been two full weeks since I have been able to dive, and it looks like it will be at least another two weeks before I can even begin to think about it again. My gills are going to dry up!
Otitis externa or “Swimmers Ear” as it is commonly referred to is a very common ailment affecting swimmers, divers, surfers, and anyone else who spends a lot of time in water. Otitis externa is the fancy technical term for an external ear infection.
Contrary to popular belief and information posted on many diving websites and forums, bacteria in the water does not cause otitis externa. It is actually caused by bacteria that is already present and lurking inside our ear canals, waiting for an opportunity to strike.
Ear wax is created by sweat glands that have been modified to produce the waxy substance that is present inside our ear canals. This necessary wax acts as a waterproofing layer that coats the canal and prevents water and bacteria from getting into the cells of the canal lining.
When the cells become saturated from frequent immersion in water they swell and pull apart just enough to allow bacteria to slip between them and find a warm moist place to grow and multiply underneath the surface of the skin. Once the bacteria is allowed to multiply and affect surrounding tissues the resulting pain begins to be noticed.
One easy way to determine where the ear is infected is by gently tugging backwards on the pinna, which is shown in the above photo. You can also gently press on the fleshy lump just in front of the ear canal which is called the tragus, If this hurts, it is an outer ear infection, if not it is a middle or inner ear infection.
If left untreated, the swelling can spread to the nearby lymph nodes and cause enough pain that moving your jaw becomes uncomfortable. At this point, the only treatment is antibiotics, either with pills, and/or ear drops, and diving is definitely out of the question until the infection has cleared up. If the infection becomes extreme, an antibiotic injection may be necessary.
It is very easy to prevent otitis externa or swimmers ear, and it will not break the bank to do it, but the following steps need to be done precisely to be effective.
Create a solution of 50% distilled white wine vinegar and 50% isopropyl alcohol, both of which can be obtained from just about any grocery store. The white wine vinegar is approximately 4-6% acetic acid, and has a pH of 3.0, which is perfect to use as a bactericidal to prevent the bacteria from multiplying. The isopropyl alcohol acts as a drying agent to draw excess water out of the cells lining the ear canal.
To administer, lay on one side and drop enough of the mixture into the ear canal to fill the canal. The most important part of the treatment is to remain still and hold the solution in the ear canal for a full five minutes. After the solution has been in contact with the ear canal for a full five minutes, turn over to allow the solution to drain and repeat with the other ear canal.
If the solution does not stay in contact with the ear canal for a full five minutes, it’s effectiveness is greatly reduced. This procedure should be done twice daily, once before the first dive of the day, and then once more after the final dive of the day.
If there is a chance of a ruptured eardrum due to a squeeze, DO NOT place drops into the ear. Doing so may inadvertently flush bacteria into the middle ear causing a worse infection problem.
If the above steps are followed exactly as described, this will prevent you from having to miss a dive because of swimmers ear.
Unfortunately I received some bad news today. On Thursday’s dive I noticed that I was having trouble equalizing my left ear and I had to force it a little bit. Apparently I forced it a bit too much, at the time I heard a popping sound but did not think too much about it because my hearing did not change and there was no immediate pain in it. That all changed on Friday though.
When I woke up on Friday I noticed pain in my left ear and my ear was plugged up so that I could hear my heartbeat. Actually hearing my heartbeat is a good thing, that is a good sign that the membrane, or ear drum, was still intact. I stayed home on Friday with a low-grade fever and took ibuprofen for the pain, hoping it would go away.
Today I woke up with the pain even worse, so I went to the hospital to have my ear checked. Even though I know what to look for and have an otoscope here in my emergency kit to see into the ear canal, I can not see into my own ears, so I was forced to rely on someone else’s opinion.
The Emergency Room physician referred me to a specialist because he thought he saw a small hole in the membrane, but he was not sure. The membrane was severely infected along with the ear canal, but he was not sure if the membrane was intact or not. So, for the next few hours I waited to get squeezed into see the specialist, worrying that I may have done permanent damage to the membrane, which could prevent me from diving in the future.
Once I was finally able to be seen by the specialist she examined my ears, noting the infections to both the canal and the membrane. She noticed what the E.R. physician had seen on the membrane but stated that she did not believe it had ruptured. It was basically like a stretch mark which was a sign of over stretching of the membrane when I forced my ears to equalize on Thursday.
Because the infection was both on the inside and on the outside, affecting both the ear canal and membrane, and middle ear she prescribed antibiotics and antibiotic ear drops for the next 15 days and benched me from diving for at least a week. If the infection has completely cleared I can resume diving after June 3rd, but if it has not completely cleared I have to wait another full week before I am cleared to dive again.
I was supposed to be assisting Michelle with another Open Water Diver class today and tomorrow for their open water dives up at Sharks Cove on the North Shore. I had to sit today out dealing with the hospital and doctors, but I will assist her tomorrow morning. I wont be able to dive tomorrow, but at least I can help out with ground support.
This not being able to get in the water for at least a week is really going to get to me. This is going to be a very long week for me. The moral of this story, if you ever have trouble equalizing your ears, DO NOT force it, not even a little bit. You may not be as lucky as I was by only having to stay out of the water for a week.