Constant ear infections

[carrielsal]

I have been diving 15 years and have never had a problem with my ears. I can equalize easily and have never had a reverse block or ear infection until 6 months ago.
I do 3-6 practice dives a week in our local lake. Late last fall/early winter I developed an inner ear infections, then about a month later a middle ear infection.
2 weeks ago I started having pain in my left ear. I waited 3 days to see if it would clear up, but the pain got worse. The doc said she saw fluid behind my eardrum and diagnosed an inner ear infection. She prescribed amoxicillin and my ear was filling better within 2 days. 4 days after being on antibiotics, I would still hear a little fluid behind my eardrum but the pain was gone. I went diving and had no problems equalizing. I finished the antibiotics this past Friday and did 3 dives on Sat. No problems equalizing. Within 24 hours my left ear started hurting inside again and I have some hearing loss.
I looked at TSandM's article on ear infections, Ear "infections".
I wonder if I have something else going on that is causing these repeat ear infections. My ear feels better after a couple of days of taking antiobiotics, but could I have inflammation in my Eustachian tube causing the water to get trapped behind my ear drum leading to infection? The lake water is pretty nasty and it's probably safe to assume that bacteria is more prolific as the water gets warmer.
I should probably go see an ENT doc, but my ear hurts and I need to be seen today, and I want to be able to have an informed discussion with the doc.
What kind of underlying medical issues could cause repeated ear infections? Are there any preventative measures that can be taken for inner ear infections?

 

[Jim Lapenta]

Carrie, are you using an ear dryer or some solution to dry out your ears after the dives. Went thru a bout of Otitis Externa a couple weeks ago. Needed some drops containing neomycin,polymyxin b sulfates, and hydrocortisone in otic suspension. Whatever the heck that all means. Made by Falcon pharmaceuticals. Doc said that the 3-4 nights a week in the pool for three weeks plus 6 AOW checkouts and then 2 more pool sessions had my ear full of junk. I had not used my alcohol/vinegar/peroxide mix for a while because I was too lazy to buy vinegar! Doc said what happened was my ears were too wet and started growing stuff. Was not able to dive for 10 days and only surface work in the pool til last thursday. Ok now but I have my mix and will make sure to use it. She suggested both before and after for a couple weeks until we are sure all the junk is indeed gone. I was also using a warm water rinse and was shocked at what was coming out of my ears. There was so much in the left that she could not see my eardrum.

It may be related if the infection is starting outside and migrating in.

 

[carrielsal]

Carrie, are you using an ear dryer or some solution to dry out your ears after the dives. Went thru a bout of Otitis Externa a couple weeks ago. Needed some drops containing neomycin,polymyxin b sulfates, and hydrocortisone in otic suspension. Whatever the heck that all means. Made by Falcon pharmaceuticals. Doc said that the 3-4 nights a week in the pool for three weeks plus 6 AOW checkouts and then 2 more pool sessions had my ear full of junk. I had not used my alcohol/vinegar/peroxide mix for a while because I was too lazy to buy vinegar! Doc said what happened was my ears were too wet and started growing stuff. Was not able to dive for 10 days and only surface work in the pool til last thursday. Ok now but I have my mix and will make sure to use it. She suggested both before and after for a couple weeks until we are sure all the junk is indeed gone. I was also using a warm water rinse and was shocked at what was coming out of my ears. There was so much in the left that she could not see my eardrum.

It may be related if the infection is starting outside and migrating in.

Jim,
My ear canal has always been fine (expect the time that I had the middle ear infection). I had asked the doc about using antiobotics drops as a preventative last time I went, but she told me that it wouldn't do any good because the infection is behind my ear drum.
Lynn talked about misdiagnosis with inner ear infections. I never rush to the doc. I wait a few days to make sure it's not going to get better on its own. After I have been on antiobiotics for a couple of days the pain goes away, so I think it's safe to assume that confirms it's an ear infection. I'm hoping Lynn takes a look at this thread and may have some words of wisdom before I go see the doc. I have been fortunate at my age I have no health issues, so I don't have a regular doc. I usually just go to a regional clinic and see whoever is available.
I'm heading to Hawaii in 3 weeks and don't want to be battling ear infections there. It's only sore on the inside, but it throbs if I lay with that ear down.

 

[carrielsal]

BTW...it feels funny calling TSandM by her first name when asking a medical question. Would Dr TSandM be better?

 

[TSandM]

Well, this case sounds like the original course of antibiotics wasn't long enough, or wasn't the right drug. Especially if you had antibiotics during the fall and winter, it's quite possible that you are carrying some moderately to very resistant bacteria. If the fluid in the ear isn't completely gone, and it isn't completely sterilized, infection can easily recrudesce.

As far as something that would predispose you to middle ear infections, where you have not had them before, anything that impedes drainage of the middle ear might make it more likely that fluid which accumulates there would get infected. In that category, I'd consider seasonal allergies, chronic sinus infection, and nasal polyps.

You might consider PMing Dr. Mike, who is an ENT doc. I haven't seen him post here in a while, but he's always been very helpful to folks who have ear-related questions.

 

[carrielsal]

Lynn,
Central Texas is one of the worst places for allergies. If you don't have seasonal allergies when you move here, the chances are good that you will develop them.
I went to see the doc yesterday. He said I now have an outer and middle ear infection....darn it. The doc didn't know much about diving (except that he thought is was scary), but I asked him to prescribe me prednisone in case I am having some irritation due to allergies that could be keeping my eustachian tubes from draining.
If I have any more problems it will definately be time to call DAN and get a reference to an ENT doc.

 

[Scott L]

Carrie,
I might suspect increased feash water diving has something to do with your repeated infliction...

 

[carrielsal]

Carrie,
I might suspect increased feash water diving has something to do with your repeated infliction...

Possibly, but I've been diving for many years in the same lake and never had problems.

 

[lulubelle]

You might try using an acidic ear drying solution after every dive. I do, for infection prevention. Ear "bugs" like wet congested environments so use of these drops gives them less opportunity to thrive. I have one ear which gets congested after every dive and when I first started diving, would develop Otitis Media. Using an acidic drying solution has kept it infection free.

Otitis isn't as clearly delineated as some would like to think. Two people with exactly the same exposure, anatomy, immune function, etc. can have differing responses.

I'm with Lynn though, i suspect you may be dealing with the same infection repeatedly due to not having the right drug, not having the right course, or having some degree of resistance. Depending on your geographic area, the level of drug resistant organisms can be quite high, 80% or so. Keep in mind the ear isn't very vascular, so getting the drug to the infection is challenging, hence the need for longer courses for some folks.

I remember a paper I did in Grad school on OM. Between drug resistant organisms and viral infections of the ear, there was only a narrow window of opportunity to actually hit the right bug with the right drug. In many countries, these infections are not treated with antibiotics very often and for good reason. But in other countries, the rate of rupture, mastoiditis, and permanent hearing loss is higher. Here in the US that is not the case. We treat everything and anything. We also have a whole generation of kids growing up with serous fluid behind their ears, conductive hearing loss as a result, and language delays. I offer this little tangent so that you will understand what your doctor is dealing with.

I'm no ENT, or MD for that matter, so please defer to their counsel on this! I'm just a Peds NP who has looked into a lot of little ears.

So your best bet is prevention.

 

[DocVikingo]

You might consider PMing Dr. Mike, who is an ENT doc. I haven't seen him post here in a while, but he's always been very helpful to folks who have ear-related questions.

Dr. Mike was here yesterday at 06:42 PM.

He can be contacted thru --> ScubaBoard - View Profile: doctormike

Regards,

DocVikingo