Chronic Otitis Externa - Persistent ear canal infection

[Juha_Kristian]

Hi there,

I would like to understand the treatment of chronic otitis externa. I was diving in Costa Rica last December and from since I have had persistent ear canal infection in left ear. After couple of days of diving in Montezuma I felt constant itch in and around ear canal. Later on the forthcoming day two days itching turned in to the very hard pain. I visited doctor in Clinic 2000 in Montezuma, and doctor misdiagnosed ear illness for middle-ear infection and gave wrong medication (oral antibiotics. Pain was just growing and I couldn't hear or equalize with infected ear. I arrived back home from Costa Rica and visited ear doctor the very same day. Ear doctor diagnosed an advanced ear canal infection by examining the ear. The doctor cleaned the drainage and debris in the ear thoroughly with alcohol liquid. Doctor prescribed Ciprofloxacin ear drops to treat ear canal infection. After the seven day prescription of Ciprofloxacin ear drops I went back to see doctor and he cleaned ear canal again with alcohol liquid and prescribed to use ear drops (boric acid and 20% alcohol). He said that acidifying agents are effective because the common bacteria responsible for ear canal infection cannot survive in a very acidic environment. He also said that I should avoid water entering the ear canal because when water is trapped in the ear canal, bacteria that normally inhabit the skin and ear canal multiply, causing more and more infection of the ear canal. I used acidifying ear drops three times every day for about four weeks and I tried to keep ear canal dry.

But it was really hard to prevent water entering the ear canal and keep ears. I tried to use Mack's earplugs they were hard, robust and I felt that they are scraping ear canal's skin again. I also tried to use moldable silicone plugs which is custom-fitted to the ear canal by the wearer. For some reason moldable silicone plugs leaked in shower or sauna. Ear canal infection has been persistent for about three months now about week ago I had a second opinion from the ear doctor who is spespecialized in divers ears and he has been working around divers for about two decades now. The doctor confirmed previous diagnose of otitis externa and told me that skin looks really infected and because I have had ear canal infection over three months it's probably in chronic stage. Doctor first cleaned the ear again thoroughly with alcohol liquid and after that he filled the ear canal with an anti-fungal cream called gentian violet dye. He also prescribed another Ciprofloxacin ear drops.

Because ear canal infection seems to be chronic Doctor strictly forbid me to let any drop of water to get in to the ear canal and told that a cotton ball saturated with petroleum jelly is most effective at keeping water out of the ear. I tried cotton ball and it worked fine in the shower. He also recommended that I should buy vented and non-vented Docs Proplugs to keep water away in the future. Doctor said that vented Proplugs can be used in scuba diving and they keep ear canal dry during the dives. I ordered both of them and hopefully they will arrive soon. Have you scuba dived successfully with Docs Proplugs? Or have you used Proplugs for swimming and other water activities?

Ear canal infection

Ear canal with Proplugs





As I look back over all the years I understand that I have made all possible mistakes with my ears:

• I have cleaned the ear canal daily with cotton swabs and that has removed the protective wax layer and lead to infection.
• I also love the water and I swim, dive and shower a lot, too much water has got into my ears. Water has removed the protective ear wax and then it has been easier for germs and fungus to grow.
• I have been using noise reduction earplugs for more that a decade for sleeping and if they are pushed too far into the ear canal, they may push earwax and debris into the canal and possibly against the ear drum. Many pathogenic bacteria grow well on warm, moist, foam-type plugs (polyvinylchloride (PVC) or polyurethane).
• I have scratched and poked the ear with my fingers when ear canal has been icthy. That have damaged the skin in the ear canal and caused inflammation.

I would like to hear more about the treatment of chronic otitis externa. What should I avoid? What home treatment should I do to prevent otitis externa to get any worse? What are the best ways to prevent water coming in to the ear canal? I mean that vented Proplugs is one option to keep ear canal dry, but is there some alternative options that I should look into?

My doctor said that there isn't' much more that modern medicine can do about chronic otitis externa and we well continue with this treatment plan:

• Gentian violet dye is used every week.
• I continue to use boric acid and alcohol drops twice a week.
• Doctor is going to clean the ear twice a week thoroughly with alcohol liquid.
• Patient is not allowed to wet the infected ear canal.

What do you think about treatment plan? Have you had similar treatment? By the way, is gentian violet safe medicine? I read that it's toxic and can cause cancer.

Here's articles about the treatment of otitis externa -> Chronic (Persistent) Otitis Externa | Health | Patient UK , Otitis externa - Wikipedia, the free encyclopedia .

Thanks in advance for any replies and good luck with your ears.

 

[DocVikingo]

Here's where to start, Juha.

- Doc Vikingo's Preventing Swimmer's Ear

- http://www.scubaboard.com/forums/di...nted-ear-plugs-work-topic-comes-up-often.html

Regards,


DocVikingo

 

[Juha_Kristian]

Hi Doc,
Thanks for an interesting article how to prevent swimmers ear which I found useful. I believe that have to keep my ear canal dry in any time for the rest of my life to prevent infections in future. The Docs Proplugs sound very promising and I hope that they would arrive here soon.

I found out that another effective solution may be the Pro Ear mask, a specially designed mask including pressure-equalized ear cups, that keep the ear dry when diving. What do you think? Should I buy Pro Ear mask too? Because I live in north and cold place called Finland , I'm usually diving with thick dry suit. I wonder is it possible to use Pro Ear mask with dry-hood?

 

[gert7to3]

I have used the Pro-Ear mask for at least five years and have been very happy with it. You really can keep your ears dry whilst diving.

I use a hooded vest with a 7 mm wetsuit. I cut ear holes in the hood for the ear cups. I made the holes fairly small so the edges go over the outer skirt of the ear cups. Since you equalize through the ear cups with exhaled air through your mask, this keeps your ears warm. I'm a Lake Michigan diver so our water temps, at depth are down to 5 degrees C or so.

IST, the company which makes the Pro-Ear mask, also makes a hood. I bought one, but did not like it because the neck skirt was too short. That hood had a thin inner neoprene liner, with ear cup holes and an outer piece, which pulls over the ear cups. SO you can wear the mask's ear cups under a hood. The problem I think this might cause you is that the ear cups will push the hood away from your head and let cold water circulate under your hood. You may want to modify the hood IST sells for use with the Pro Ear mask.

I just searched Pro-Ear Mask and saw a photo of your dry suit from another thread. I definitely think you should try the Doc's Pro Plugs first. Doc's Pro Plugs won't always keep your ears completely dry. The surface tension of the water over the tiny vent holes is overcome by 7-10 m depth. Pro Plugs may keep water out a bit deeper with that tight, integrated hood. My discussion is also in that thread from 2007.

My avatar shows me wearing a Pro Ear Mask.

Here's a modification I made to a favorite mask where I transplanted Pro Ear Mask ear cups to it:
http://www.scubaboard.com/forums/fins-masks-snorkels/315937-pro-ear-mask-earcup-transplant.html

 

[Thalassamania]

Good discussion of the issue: Effect of Diving and Diving Hoods on the Bacterial Flora of the External Ear Canal and Skin (http://jcm.asm.org/cgi/reprint/15/5/855.pdf)

DAN recommends half and half white vinegar and rubbing alcohol. While Vinegar/alcohol is good, what we used for earwash on the Tektite Project back in 1969 was equal parts of 15% Tannic Acid (15 gm. diluted to 100 ml), 15% Acetic Acid (15 ml diluted to 100 ml) and 50% isopropyl or ethanol (50 ml diluted to 100 ml) in a wash bottle. On Tektite we used ethanol because we had a bunch in the lab for pickling specimens. If you leave a wash bottle full of solution in the sun (e.g., on the dash of your car) it feels so good after the dive.

If you have access to any High School or College chemistry lab you can make it. Or you can likely get a pharmacist to make it up (get you doc to write it out as a prescription) or just get the stuff you need from any Chemical Supply company

1) Tannic acid (crystals), weight out 15 grams, transfer to a 100 ml volumetric flask and fill with water.

2) Acetic acid (liquid) put 50 ml or so of water into a 100 ml volumetric flask, slowly add 15 ml of glacial acetic acid then dilute to 100 ml with water.

3) Dilute an appropriate volume of alcohol with water so that you get 100 ml of a 50% alcohol solution.

Combine equal parts of the three solutions (in this case 100 ml each to make 300 ml of Tektite Solution).

Mineral oil in the ears before the dive and Tektite Solution after. I've done this since '69 and never had any problems with my external acoustic meatus.

 

[Juha_Kristian]

Hi there,

The postman delivered the letter from Proplugs manufacturer. This letter was something I have been impatiently awaiting here. I think, therefore, that this is a check to be done immediately. So I installed both Proplugs in to the ear canal and took a shower. In the beginning, Proplugs worked great but after a minute of standing in a shower I got familiar feeling and slowly the ear canal was flooded with water. Oh bummer. After for about 12 hours the ear canal was once more inflamed and sore about the water.
And here comes my second question, it is about sizing the Proplugs. Do you think that i have right size of proplugs? Is there something else that I could try to keep the plugs leak proof? It seems that I plastic part between crus helix (4) and tragus (3) is rising and that would seem odd to me. Mayby the plug is leaking water from there?

Vented model

Non vented model

Proplug sizing instructions

Proplugs sizing

Gert, I will try to get my hands on a Pro ear mask and give it a try. Your experience and results are encouraging. However, i have to solve the problem how to use Pro ear mask with dry-suit's integrated and stiff dry hood. Diving in warm water is a no-brainer because there we can use loose neoprene hoods with Pro ear mask.

Article named: Effect of diving and diving hoods on the bacterial flora of the external ear canal and skin was really interesting. I don't have access to any High School or College chemistry lab, but I will take to my ear doctor about this. Maybe he can help me to get ingredients of this alternative solution.

I must resolve this situation how to keep my ear canal dry in the water and to avoid the pattern of continuous otitis externa. I love the ocean, the river, the pool...anywhere on the water is my home and I have to get back as soon as possible.



P.s. What is happening to the pictures and why

 

[DandyDon]

The IMG code is blocked in this forum. Don't know why but has been for a long time. Your attachments worked well.

Glad you got your own thread started for more personal focus. I don't think vented plugs can keep your ear dry at all, and non-vented won't allow equalizing, but that ear mask looks promising. Good luck.

 

[gert7to3]

Juha,

I don't think the shower was a good test for those Doc's Pro Plugs. They rely on even surface tension of the water over that tiny hole to prevent water entry. A shower spray is not what they are designed to resist. The ear plug is also resilient, flexing deeper into the ear canal as water pressure increases with depth, compressing the air pocket. There may be a some water entry, but it will not be the flushing immersion experienced in an unobstructed outer ear canal.

One thing you might try to seal the Pro Plugs more firmly is to apply a thin bead of silicone putty ear plug material, used for sound protection or surface swimming, around the perimeter of the Pro Plug. This may tuck them into place more securely. Be very careful not to obstruct the vent hole. I recall doing this myself when I discovered that my mask strap could dislodge the Pro Plug. I think the Pro Plugs ought to work, especially combined with your hood system.

A source for Thalassamania's formula could be from your local pharmacist (drugstore in the U.S.).

 

[Juha_Kristian]

I'm just reading on the articles of chronic otitis externa here in PubMed and Scholar. It seems that otitis externa remains a frustrating problem for both patient and physician. It also seems that no single therapy will be successful for every patient. I have had the ear canal infection now for about four months and misery goes on. I don't know what should I do next.
Some of these clinical studies are suggesting that biofilm is the cause of chronic otitis externa and chemical ear peeling treatment is effective against bifilm. Do you have more information or experience of chemical ear peeling treatment?

The IMG code is blocked in this forum. Don't know why but has been for a long time. Your attachments worked well.

Glad you got your own thread started for more personal focus. I don't think vented plugs can keep your ear dry at all, and non-vented won't allow equalizing, but that ear mask looks promising. Good luck.

Bummer. It's always easier to explain and spin a yarn with pictures. Admin, is it possible to turn the IMG code on in this forum?

I have understood that Docs Proplugs are sold on the argument that they prevent the water entering the ear canal and keep them dry.

Juha,

I don't think the shower was a good test for those Doc's Pro Plugs. They rely on even surface tension of the water over that tiny hole to prevent water entry. A shower spray is not what they are designed to resist. The ear plug is also resilient, flexing deeper into the ear canal as water pressure increases with depth, compressing the air pocket. There may be a some water entry, but it will not be the flushing immersion experienced in an unobstructed outer ear canal.

One thing you might try to seal the Pro Plugs more firmly is to apply a thin bead of silicone putty ear plug material, used for sound protection or surface swimming, around the perimeter of the Pro Plug. This may tuck them into place more securely. Be very careful not to obstruct the vent hole. I recall doing this myself when I discovered that my mask strap could dislodge the Pro Plug. I think the Pro Plugs ought to work, especially combined with your hood system.

A source for Thalassamania's formula could be from your local pharmacist (drugstore in the U.S.).

Ok. I haven't been been able to test the non-vented Proplugs in the pool. Otitis externa is still in the acute phase so I'm afraid of letting the water inside the ear canal.
I ordered Pro Ear mask from Simplyscuba.com and I would like to give it a try it in pool as soon as possible.

I think there's nothing else I can do to get rid of the persistent ear canal infection? By the way, Thalassamania's formula is not available here in European drug stores.

 

[gert7to3]

Juha,

Do not use the non-vented Docs Pro Plugs for diving. They are not for diving, so there is no need to test them. Only the vented Docs Pro Plugs (with the hole) are for diving.