Question Diving with swimmer's ear

[beediving]

I'm in Raja Ampat right now and I think I have swimmer's ear for the first time in my life (left ear). I only have a few days left here and would love to go diving and snorkeling. I'm taking amoxicillin (oral) and using Anauran ear drops (poliximin B, neomicin, lidocaine). I'm also taking ibuprofen, thinking it may help if I have an inflammation.

I only have a little pain when I pull the ear, or press a finger on the side of the ear (trago area). But I feel the ear canal is swollen.

I can equalize the ear. When I move my jaw, I hear better, depending on the jaw position. Just sometimes I feel as if the hearing was muffled. Yesterday it was worse: the ear was muffled for several hours and when I had dinner, chewing was a bit painful. Just a bit. Today, no pain while eating. It just feels a bit weird.

My question: since I'm using the drops to kill the bacteria and I can equalize the ear, could I go diving and snorkeling?

I'd use the drops after being in the water, to kill any extra bacteria getting there.

I don't want to hurt myself, but perhaps it is OK to dive? You all know how frustrating it can be.

I thought of snorkeling with ear plugs for swimmers, which I have, but my ear canal is tiny. I can never fit the plugs without pain. It is tiny not just now, but in general. Now, it's even tinier, because it is swollen. I mean, narrow.

The oral antibiotics, I'm thinking of stopping after 4 days, because I've read it isn't effective against swimmer's ears. Any thoughts?

Thank you in advance for any help!

(I've just noticed it isn't muffled anymore, but it feels a little sore)

 

[kaylee_ann]

Maybe @Duke Dive Medicine would have an idea?

 

[Duke Dive Medicine]

I'm in Raja Ampat right now and I think I have swimmer's ear for the first time in my life (left ear). I only have a few days left here and would love to go diving and snorkeling. I'm taking amoxicillin (oral) and using Anauran ear drops (poliximin B, neomicin, lidocaine). I'm also taking ibuprofen, thinking it may help if I have an inflammation.

I only have a little pain when I pull the ear, or press a finger on the side of the ear (trago area). But I feel the ear canal is swollen.

I can equalize the ear. When I move my jaw, I hear better, depending on the jaw position. Just sometimes I feel as if the hearing was muffled. Yesterday it was worse: the ear was muffled for several hours and when I had dinner, chewing was a bit painful. Just a bit. Today, no pain while eating. It just feels a bit weird.

My question: since I'm using the drops to kill the bacteria and I can equalize the ear, could I go diving and snorkeling?

I'd use the drops after being in the water, to kill any extra bacteria getting there.

I don't want to hurt myself, but perhaps it is OK to dive? You all know how frustrating it can be.

I thought of snorkeling with ear plugs for swimmers, which I have, but my ear canal is tiny. I can never fit the plugs without pain. It is tiny not just now, but in general. Now, it's even tinier, because it is swollen. I mean, narrow.

The oral antibiotics, I'm thinking of stopping after 4 days, because I've read it isn't effective against swimmer's ears. Any thoughts?

Thank you in advance for any help!

(I've just noticed it isn't muffled anymore, but it feels a little sore)

Hi @beediving ,

Without a detailed knowledge of your health history, specific recommendations for this via the internet may not be accurate or even safe. A few general thoughts:
Continuing to expose the inflamed tissue of your ear canal to sea water will likely, at the very least, prolong your recovery time, and could worsen the infection.
If you were prescribed oral antibiotics, it is prudent to finish the course as it was prescribed. It is not true that oral antibiotics are ineffective against otitis externa. Stopping them now means that you killed the bacteria that are most vulnerable to the antibiotic and left the ones that aren't. Those that are left would then proliferate and possibly leave you with a resistant infection.

Best regards,
DDM

 

[beediving]

Thank you so much for your replies!

Thank you, @Duke Dive Medicine!

I wouldn't mind to delay recovery if I could dive my last days here. I'm leaving next week on Wednesday.

But I don't want to risk getting to a point where I couldn't fly. Missing my flight would be really bad.

I wonder if it could get bad to the point of not being able to fly on Thursday.

I'll be patient.

 

[Duke Dive Medicine]

Thank you so much for your replies!

Thank you, @Duke Dive Medicine!

I wouldn't mind to delay recovery if I could dive my last days here. I'm leaving next week on Wednesday.

But I don't want to risk getting to a point where I couldn't fly. Missing my flight would be really bad.

I wonder if it could get bad to the point of not being able to fly on Thursday.

I'll be patient.

I wish I could answer that question. It would be hard to picture otitis externa becoming bad enough to prevent flying especially in the setting of both oral and topical antibiotics, but I don't know your medical history or have an objective view of the current state of your ear. With repeated exposure to the water, you'd be at risk of the infection worsening and turning into cellulitis or something more. That risk is something that only you can determine based on your knowledge of yourself, your prediction of what may happen, and advice from a health care provider who has evaluated you in person.

If you choose to dive or snorkel, it would be reasonable to rinse your ears, especially the affected one, thoroughly with clean fresh water right afterward and perhaps consider using an over-the-counter antimicrobial ear solution after the rinse, making sure that you let it dwell in the ear for the recommended time, usually at least five minutes. If that's not available, you can approximate one with 50/50 white vinegar and low-concentration rubbing alcohol. Be prepared for the alcohol to cause some pain. Again, it is entirely up to you to weigh the benefits of diving/snorkeling against the potential risk, which is best known to you and the provider who prescribed you the antibiotic.

Best regards,
DDM

 

[Duke Dive Medicine]

Also, @doctormike : is amoxicillin first-line for otitis externa <edit: related to a waterborne organism in Raja Ampat>?

 

[kinoons]

I am also not your clinician, post is for educational purposes, etc…

DDM is right on about continuing to dive with OE. When I’ve had OE from diving in both instances starting the antibiotic/steroid ear drops very rapidly improved my symtoms. Continued exposure before recovery runs a risk or worsening your condition.

In my experience amox wouldn’t be my first choice for OE. Generally a topical is enough, and if oral antibiotics were added something like cipro or keflex would be my usual first choice. Unless the OE was very severe, associated with uncontrolled diabetes, or classified as malignant (in that case IV antibiotics are indicated) I stick to just the drops.

 

[Joneill]

Thank you so much for your replies!

Thank you, @Duke Dive Medicine!

I wouldn't mind to delay recovery if I could dive my last days here. I'm leaving next week on Wednesday.

But I don't want to risk getting to a point where I couldn't fly. Missing my flight would be really bad.

I wonder if it could get bad to the point of not being able to fly on Thursday.

I'll be patient.

I hope you realize that, in this situation, the sensible thing would be to forgo diving and let your ear heal - If you choose not to do that, you risk more significant infection and, possibly, permanent damage.

So... it's your ear and your health = your decision! No one here can guarantee you won’t develop more serious issues if you decide to risk diving/snorkeling with an ear infection.

 

[Duke Dive Medicine]

In my experience amox wouldn’t be my first choice for OE. Generally a topical is enough, and if oral antibiotics were added something like cipro or keflex would be my usual first choice. Unless the OE was very severe, associated with uncontrolled diabetes, or classified as malignant (in that case IV antibiotics are indicated) I stick to just the drops.

Thanks for that. That aligns with what Up-to-Date recommends for waterborne organisms.

@beediving , did you buy the antibiotics over the counter and self-prescribe? Probably should have asked that at the start.

Best regards,
DDM

 

[beediving]

Thank you very much for your replies. I realize no one can give me medical advise on a forum and your words are for educational purposes.

@Duke Dive Medicine, I had the medicines with me to use in case something happened. The kind of thing one prepares when going to be in a very isolated place.

I started using at the first symptoms. The symptom 1 was a little soreness when I pushed the trago with my finger. I wondered if it could have been from sleeping on the ear, but them I realized the ear canal was swollen: I'd hear better from this ear when yawing. I had no problems with equalizing. I usually equalize by just swallowing, no pinching nose and no blowing, without difficulties.

I think all your cautious words are right and I had already decided it isn't a good idea to push my luck. When I said I'd be patient on my reply, I meant it.

I wouldn't risk not being able to fly back home. I also thought that I'd spend the whole dive worried, thinking what would happen to my ears on the ascent, if my condition worsened during the dive.

I wish I could use the earplug for snorkeling (just on the surface, of course, no freediving).