Treating an Ear Infection in the 3rd World

[DocVikingo]

Hi Dave,

Funny, but a possible relationship between the recent URI and present condition actually did cross my mind as it certainly would be odd for an infection directly related to the dives described to have an onset of that rapidity and severity.

As you know, the pathogens involved in URIs can traverse the Eustachian tube and raise hob in the middle ear. However, it is my impression, and perhaps I'm mistaken, that such infection was most likely during or shortly after a symptomatic URI, and this inquirer describes feeling perfectly fine for about the past 3 weeks.

Guess we'll never know.

Regards,

DocVikingo

 

[ScubaKay]

Thank you all for your quick and helpful responses.

Arizona - your recommendation on the Doctor (and Japanese Restaurant...yum) in Samui is quite valuable. I'm printing it out now... Hopefully will not need it, but good to have just in case.

DocVikingo - thanks also for your information and advice. Would you mind expanding on your comment about the possibility of it being a mechanical trauma? For my (and other readers) educational purposes - as I'm not familiar.

Couple other updates/notes:

- I now think the rash is unrelated. The rash is not consistent - a line of dots here and there, a splotch of dot here and there. And located only on sections of my limbs that were not protected by my shortie wetsuit. Possibly a delayed reation to jelly fish, coral, etc?

- A close relative who is a Pharmacist recommended I stop taking the oral antibiotic (Levofloxacin) since there is evidence that oral antibiotics are not beneficial to treating otitis externa (swimmer's ear) - unless the infection is systemic. In which case, other symptoms such as fever, naseau, etc would need to be present.

So, here I am in this beautiful paradise. Sadly, I can neither dive, nor take in a relaxing Thai massage (the rash...). Can I at least have a Singha or Chang beer to go with the Penang Curry?

Thanks again everyone. I'll let you know what happens...

 

[DocVikingo]

Hi ScubaKay,

You're welcome.

Discontinuing the Levofloxacin based on the opinion of a non-physician who has not examined the ear, and without direction from the prescribing source, arguably is quite questionable.

For openers, the description "...had problems equalizing my left ear. Finally a long squeak and my ear equalized and I continued downward. 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" is not particularly consistent with swimmer's ear (otitis externa). The description is, however, rather consistent with a middle ear problem, perhaps one involving an infectious component.

Perhaps the pharmacist based the recommendation on the statement, "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." While it is unclear exactly what this means, be aware that examining the ear with an otoscope can reveal redness and swelling of the ear drum, a finding very suggestive of a middle ear infection. Fact is, only the prescribing individual at the clinic knows for sure and is the one seemingly in the best position to be making the calls at the moment.

In any event, in the absence of problematic side effects or other sound medical reason for stopping an antibiotic, it generally is considered good pharmacological practice, and wise patient behavior, to finish the entire prescription once it has been started.

Concerning "mechanical trauma," the middle ear is a rather fragile system in parts and fairly easily damaged by barotrauma such can be occasioned by significant difficulty with equalization. There can be resultant bleeding and exudation of other fluids into the middle ear space which do not properly drain and cause a sensation of congestion, muffled hearing, crackling sounds upon chewing or swallowing, and eventually pain and infection. There are multiple nerves passing through and near the middle ear and sinus cavities which can be impacted by barotrauma. Also, the mastoid bone is located behind the ear and is connected to the middle ear through an air filled cavity. Under certain circumstances it can be affected by barotrauma and infection can spread between these two spaces.

As a concluding remark, it's probably not helpful to be unduly pessimistic about the quality of care and drugs available at smaller clinics in Thailand and could lead to poor decisions. If there are serious concerns, travel to a larger facility with an ENT would be prudent.

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