Treating an Ear Infection in the 3rd World

[ScubaKay]

I realize this topic (Ear Infections) is been posted at least every week... so Extra Thanks in advance to those who read and respond to my posting!

I just started a 5 month trip around Southeast Asia. Just a few days into the trip, I've been diagnosed with an Ear Infection in my left ear. After only the 1st day of diving!

I am a bit worried since this is a 1st time infection, and I am currently restricted to the very limited medical resources available on a small island (Ko Tao, Thailand). No hospital, just a small clinic. I'm not even sure the medic I saw is a nurse, doctor, volunteer, or just an hourly desk clerk.

So - any advice? Does this infection sound typical - or should I be concerned and seek mainland professional help? Do the drug prescriptions sound appropriate?

Thank you!
ScubaKay


DETAILS
Medical History:- Never had an ear infection...ever
- Had a bad upper respiratory infection (coughing, yellow mucus, sneezing, etc) about 1 month ago - but felt perfectly fine the last 2-3 weeks. Treated the infection with just ibuprofen & sleep.

This trip:- Flew from US to Bangkok on Thurs/Friday. Spent 2 days in Bangkok, then took an overnight bus and ferry to Ko Tao.
- Arrived in Ko Tao on early Monday morning. No diving on Monday - spent the day resting.
- Tuesday morning, went on 2 dives. Ear infection immediately after.

Dive details:
- On the 1st dive (max depth 60 feet), had problems equalizing my left ear. Finally a long squeak and my ear equalized and I continued downward. No problems during dive or ascent.
- About 2 hours later on the 2nd dive (max depth 40 feet), I had no problems descendng at all. Quick and easy. No problems during dive or ascent.
- Within 30 minutes of completing the dive, my ear started to ache and felt clogged (like when you are on an airplane)
- The pain progressed rapidly. Within an hour, I could not hear from my left ear and it throbbed in pain. Within a couple hours, my entire left side of my face (eyes, throat, etc) ached in pain as well.
- Talked to the Dive Master/Instructor, and he recommended I visit the island clinic around the corner.
- The girl working the clinic took a quick (2 seconds in each ear) look into the ears and said it is very swollen and I have an infection. She prescribed the following:

- Levofloxacin Antibiotic. 500 mg tablet, 1 per day.
- Ibuprofen. 400 mg tablets, 3 times a day.
- Antibiotic drops to treat "ear affections" (that's what the package says!). Contains Furaltadone hydrochloride, Polymyxin B sulfate, Neomycin Sulfate, Fludrocortisone acetate, Lidocaine hydrochoride. 2 drops, 4 times a day.

The drugs are all manufactured in Thailand by pharmaceutical companies I have never heard of.

I've already developed a skin rash (arms and legs), presumably from the antibiotics. I have a known allergy to pennicylin - but have never heard of or taken Levofloxacin!

 

[Bubble Junky]

The drugs are all manufactured in Thailand by pharmaceutical companies I have never heard of.

So ?????

 

[DivingPrincessE]

So ?????

I can see his concern. I doubt that Thailand has anything equivalent to the FDA with strict rules about what drugs are on the market.

 

[hvulin]

ha ha, fda=strict???? most drugs that fda allows in us are forbidden in eu, guess why!

just use the cure they give you, it won't kill you...

 

[Arizona]

ScubaKay

Disclaimer: I am not a doctor!

Your rash could be related to something else (e.g. laundry soap, bug bites...). If it gets worse take the Sea Tran to Samui and go to one of the hospitals. It's a 2 hour ride to Samui or less and then a 10-15 minute cab ride to the hospital. Have the hospital give directions to the cab driver if you have a problem with language via your mobile phone. The number & address is listed below. I know for a fact the one by Tesco Lotus has a doctor who dives.

Thai International Hospital Koh Samui
(Opposite Tesco Lotus) Located on the Ring Road
Northern Chaweng Beach Rd, 90/2 Moo 2
24-hour number: 077-414 400-9
Ask for DR. Dulyakit Wittayachanyapong (Medical Doctor/Scuba Diver)

This comes from my emergency plan developed during my Divemaster training. It was completed in July so it is up to date.

Oh, to make you feel better after visiting the hospital, try Fuji Japanese restaurant in Tesco Lotus. Great food and cheap!!

Good luck,

Arizona

 

[DocVikingo]

Hey Arizona,

Now there's some useful info.

Good show.

Regards,

DocVikingo

 

[Arizona]

Thanks DocVikingo!

Can we move this to the Thai forum? This may help people visiting the area and it seems more appropriate. Maybe rename the thread "Treating an Ear Infection in Koh Tao"?
--------------------------------------------
ScubaKay,

Let us know what happens. I would give the drugs a try and if it gets worse go for plan B offered earlier.

Arizona

 

[vladimir]

What about the leeches and bloodletting? Isn't that pretty standard?

 

[DocVikingo]

Hi ScubaKay,

Given the rapid onset and progression of the complaints described, one has to wonder about the probability of infection versus mechanical trauma to the middle ear and related structures.

Considering the circumstances, however, if the diagnosis made by the clinic is correct the drug regimen started appears a reasonable one. It should address most infectious processes of either the middle or external ear and provide some pain relief.

Levofloxacin is a fluoroquinolone antibiotic, while penicillin is a beta-lactam antibiotic. These are different classes of drugs and sensitivity to penicillin doesn't necessarily mean one will have an adverse reaction to levofloxacin.

Mild skin itching can be a side effect of fluoroquinolone, but a frank rash can be a sign of an allergic reaction. The clinic should be informed of this development. If hives, breathing difficulties, swelling of the face, throat or lips, or other indications of a significant allergic response appear, the drug should be ceased immediately and the clinic immediately notified. This antibiotic also can result in sensitivity to ultraviolet rays, so be sure to stay well protected from exposure to sunlight.

Surprisingly, for a number of reasons the quality of antibiotics produced in Thailand appears to be quite high in general. There is no apparent reason for undue concern over this issue.

If this drug regimen is going to be effective, benefit should be noticeable within a few days. If one is not feeling improved relatively quickly, the diagnosis and treatment should be revisited. "Arizona" seems to have provided a valuable resource should the local clinic not be able to handle the illness.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

Regards,

DocVikingo

 

[pickens_46929]

DocVikingo,

I am wondering with the recent "serious" URI, that it was never really cleared and that the travel and all has simply allowed the previous URI to rekindle as an ear infection...

Just curious on your thoughts.

Good luck ScubaKay!

Dave