Managing scuba ear problems (not equalizing)

[DandyDon]

Probably, but I read that as a solution made up of one half vinegar and one half alcohol.
The vinegar that you use is 4%. I didn't read 50% as the alcohol content.

Sorry, I guess I should have said I mix equal parts of white vinegar with 4% acid and 50% alcohol.

I mix white vinegar with 4% acid equally with 50% alcohol

 

[Ukmc]

It surprised me too that the ENT implied general practitioners seem to prescribe that antibiotic mixture for every ear infection whereas ENTs don't mess around with it. (It was my impression he was implying that.) It is possible that that stuff is generally considered the first line of defense, and if it doesn't work, then the general practitioners know to move on to what the ENT prescribed (and apparently would have prescribed from the get-go). More likely, a GP would have sent me to the ENT. I'm convinced the delays involved in those visits exacerbated my infection. Sorry for the rant, but I now understand ear infections are nothing to mess around with. I would suggesting getting them treated immediately, preferably by an ENT, and definitely not chancing it by delaying while you first try self-medicating.

p.s. I brought the swimmers ear drops on that trip and used them ... sporadically. Nowadays I use them religiously!

Hmm. It sounds like ENT had an advantage of knowing that your first drop didn’t work so he could prescribe something else. It is not a bad practice for a general practitioner to start with something simple (time tested drop that has been around for like 50 years) and if doesn’t work to refer and escalate the treatment to something more potent. It doesn’t mean that general practitioner did not know what he was doing. Different bacteria have different level of drug resistance or it could have even been fungus which would have been not be helped by antibiotics altogether.

 

[Ukmc]

I went to a walk-in clinic here in the US--a chain affiliated with a local hospital--after returning from Mexico with an ear infection. The nurse practitioner there prescribed some antibiotic drops--neomycin/polymyxin with hydrocortisone (I'm reading off the bottle I saved). The visit was something like $100. My ear infection not only didn't improve but it worsened, so I went to an ENT. The ENT told me the docs-in-a-box places always prescribe those kind of ear drops and they are not what I need, so he prescribed some other antibiotic drops. I don't know what the ENT charged; probably at least another $100. My health insurance is a high-deductible/HSA plan, so it all came out of my own pocket in the end. The infection resolved with the drops. However, my hearing in one ear has never been quite the same.

My takeaways from this experience are that quality medical treatment isn't a given even in the US, and I would not trust anyone less than a specialist to treat an ear infection, let alone self-medicate using something I bought over the counter in Mexico.

My takeaway from this experience is to bring your own ENT diving buddy on the trip with you. He will take care of your ear problems

 

[Lorenzoid]

Hmm. It sounds like ENT had an advantage of knowing that your first drop didn’t work so he could prescribe something else. It is not a bad practice for a general practitioner to start with something simple (time tested drop that has been around for like 50 years) and if doesn’t work to refer and escalate the treatment to something more potent. It doesn’t mean that general practitioner did not know what he was doing. Different bacteria have different level of drug resistance or it could have even been fungus which would have been not be helped by antibiotics altogether.

Not to belabor this, but my impression of the ENT's statement--just how I read his words and tone at the time--was that he, as an ENT as opposed to a walk-in clinic practitioner, would have used the "more potent" drops first; the common polymyxin-hydrocortisone drops are not what ENTs prescribe. Again, just my (perhaps incorrect) interpretation of his words and tone. Since I only tried the walk-in clinic as a first step, where I was seen by a nurse practitioner, and did not see a GP, I don't know whether a GP might have prescribed something different or whether a GP might have prescribed the same polymyxin-hydrocortisone drops and then if that didn't work would have prescribed something "more potent." The ENT's remark was directed at the walk-in clinic.

Whether it might have been a fungal or resistant bacterial infection is why, when that first Rx didn't work, I went straight to the ENT rather than making an appointment with my GP.

That ENT just retired, by the way. I fear if I am going to make a habit of diving in Mexican cenotes I might want to find a new ENT And if the infection appeared while in Mexico, I would insist on seeing a specialist.

Anyway, my point in relating this story was simply to suggest that ear infections are nothing to fool around with. If you want to experiment with self-medicating using some antibiotic drops you bought in Mexico over the counter, you may be wasting valuable time during which the infection may worsen, perhaps causing permanent damage.

 

[cvchief]

I use Doc's Pro Plugs all the time to help with equalizing. ENT told me to use them. Wonder if they help with ear infections?

Doc's Proplugs Vented Combo Pack

 

[Dan G]

I use Doc's Pro Plugs all the time to help with equalizing. ENT told me to use them. Wonder if they help with ear infections?

Doc's Proplugs Vented Combo Pack

I get ear infections more easily than most adults and I have used these a bunch. They helped me because the water would not rush into my ears during water entry compared to how it felt without them. This made it much easier for me to get the water out of my ears after dives, which reduced the occurrences of infection. I do not use them when I wear my hooded vest, which is often and the hood provides a similar effect as the plugs. (the plugs plus the hood made me 99.9% deaf at depth, too) I have now made it a point to wear something on my head that covers my ears on every dive, including one of those sun-blocking tubes that people wear when they fish to keep the sun off their head and neck. I have found this to be more manageable than the plugs.

Cheif, I know that you know that I am not giving you medical advice, but this is my disclaimer for anyone else who may think that I am. Hope that provides some insight.

 

[uncfnp]

The ENT told me the docs-in-a-box places always prescribe those kind of ear drops and they are not what I need, so he prescribed some other antibiotic drops.

Most of the followup posts have addressed this well but as an FNP at a doc in a box I will confirm that the initial treatment is a very common, cheap older drug that is effective in most cases. I don’t prescribe it but not because it isn’t a good first choice but because a fair number of people react to neomycin. And yes, the specialist has the advantage of knowing what did not work and likely the second drop he used was considerably more expensive (cash price).

So why not just use the *strong drug* first? Use of newer broad spectrum antibiotics as first line treatment for minor infections promote drug resistance.

It is a very rare swimmer’s ear that needs a specialist and nothing about swimmer’s ear should cause hearing loss after the infection has resolved.

 

[Lorenzoid]

So why not just use the *strong drug* first? Use of newer broad spectrum antibiotics as first line treatment for minor infections promote drug resistance.

Well, that ENT retired recently, so he won’t be promoting drug resistance any longer—again, assuming my impression was correct that he was saying he would have prescribed the other drops first.

Sorry for the slight against all docs-in-the-boxes.

It is a very rare swimmer’s ear that needs a specialist and nothing about swimmer’s ear should cause hearing loss after the infection has resolved.

All this happened just before the Covid lockdown, and then the ENT retired. I didn’t have a chance to see him for a follow up. The hearing loss, which is extremely slight—just enough to be noticeable—hasn’t changed in all this time, but if there is a chance it could be restored I’d gladly see another ENT.

 

[uncfnp]

Well, that ENT retired recently, so he won’t be promoting drug resistance any longer—again, assuming my impression was correct that he was saying he would have prescribed the other drops first.

Sorry for the slight against all docs-in-the-boxes.



All this happened just before the Covid lockdown, and then the ENT retired. I didn’t have a chance to see him for a follow up. The hearing loss, which is extremely slight—just enough to be noticeable—hasn’t changed in all this time, but if there is a chance it could be restored I’d gladly see another ENT.

My absolute favorite antibiotic drops for OE is Ciprodex but along with other drugs the price has gone through the roof in recent years. My back up is actually an eye drop that has the very same antibiotic but without the steroid and is dirt cheap (at least compared to Ciprodex).

 

[DandyDon]

My back up is actually an eye drop that has the very same antibiotic but without the steroid and is dirt cheap (at least compared to Ciprodex).

With all due professional respect, ear infections have had me on the verge of tears, unable to do anything, so do not waste my time with drops that do not contain needed pain relief of steroids.