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SWIMMERS EAR – DIY solutions while travelling abroad

Whilst suffering from another ‘regular’ surf injury,

this time a few broken ribs due to a very unpredictable gnarly shore break, it seems like the perfect moment to assess this particular topic.

Whilst suffering from another ‘regular’ surf injury, this time a few broken ribs due to a very unpredictable gnarly shore break, it seems like the perfect moment to assess this particular topic.

As a traveling doctor and water lover I have, inevitably, encountered or personally suffered from some (sometimes serious) medical incidents: usually, these happen in, well, not the best of places, often worsened by bad logistics and lack of medical supplies. By sharing some of my knowledge and experience I’m hoping I’ll spare you – or at least lessen – some unnecessary suffering of common ailments or injuries, starting with this column focused on one very common problem: Otitis externa, better known as ‘swimmers ear’.

As a GP, I prefer to focus on prevention instead of treatment, therefore offering you some tips & tricks that should be applicable in even the remotest of places. As they say: forewarned is forearmed.

Mind you that these are NOT extensive lessons or explanations but simple tips and tricks! If you experience severe pain, fever, hearing loss, dizziness, even the smallest suspicion of a perforated eardrum or ongoing problems ALWAYS consult a doctor IN PERSON!! Also, there are NO economic interests involved in this column.

The external ear canal allows for reception of sound waves, guiding them to the middle ear for further internal processing whilst preventing direct impact on the fragile eardrum. Since the canal is open to the outside world, pathogens (bacteria, fungi, even insects) can easily access and inhabit this space. To protect itself from these invaders, the ear produces cerumen, a viscous acidic water-repellent substance. The canal has the ability not only to protect but also clean itself by pushing old cerumen (mixed with dead tissue and pathogens) out through jaw movements. Therefore, the presence of cerumen (and some bacteria) in an ear is absolutely normal and healthy!

Through frequent immersion in water, the cells lining the external ear canal can swell up through absorption of this water, creating small cracks in the skin. This allows the normally innocuous bacteria to crawl underneath the skin, residing and multiplying as they please. Cerumen will also absorb water and expand, blocking the canal. By manipulation (cotton tips, earbuds) cerumen can be pushed deeper into the ear canal, impeding expulsion. The presence of exostoses (bony protrusions in the external ear canal better known as surfers ear, a topic I will address in a future column) can worsen this entrapment even more.

The result? Entrapment of pathogens and debris, leading to inflammation. Usually, it starts with slight itching of the ear canal, followed by pain, hearing loss (as if you’re underwater), smelly discharge and sometimes even fever. When it gets to this point, you already need medical eardrops, usually containing an acidic solution with corticosteroids or even antibiotics. Personal experience has proven that availability of these drops can be limited and the symptoms can be very uncomfortable, to say the least.

What can you do to prevent this? Since staying out of the water is nobody’s preferred choice, we must make do with what we have.

Prevention of water entering the ear canal all together is probably the most effective: Earplugs made of cotton balls tipped with Vaseline, covered up with sports/plaster tape covering the whole ear canal can be an emergency solution. A better option is to get professional earplugs made for water activities, or even better: personalized ones made by hearing aid stores (and believe me, they are not very expensive and worth the money).

Another option is ‘ear beer’: a solution of acetic acid mixed with isopropyl alcohol or water that can be administered into the ear canal before and after contact with water. The effectiveness is based on drying out the canal and restoration of the low pH. This prevents swelling of the cells, residue and overgrowth of pathogens, all potential causes of an otitis externa.

Since the restoration of the pH seems the more effective preventive measure of the 2, the used mixture should always contain an acidic component, usually acetic acid (a.k.a vinegar). Several premixed drops are available, some on prescription, some over the counter. It is also possible to make your own ‘home-brewed’ ones: a wide range of recipes is known, but only a few I’ll advise here.

Some recipes advise the addition of moisturizers like propylene glycol which can cause undesirable effects like keeping the canal too moist and ‘gooey’, therefore I do NOT advise the addition of this component.

When creating your own concoction, do NOT use undiluted vinegar as this can be too acidic and cause irritation.

The best mixtures are:
• White wine vinegar ( with an average of 4 – 6 % acetic acid ) mixed with isopropyl alcohol in a 50:50 ratio. If your ear canal feels sore with this mixture, it’s advisable to lessen the ratio of the alcohol, e.g. ratio of vinegar 60:40 alcohol or vinegar 70:30 alcohol.
• White wine vinegar with ‘normal’ water in a ratio of 50:50.

You can poor either of these mixtures directly into the ear canal: tilt your head sideways or lay down with your head turned sideways so one ear is facing up, ‘fill’ your ear with the fluid and leave it in for no less than 5 minutes (yes, set a timer!!). Shorter exposure lessens the effectiveness drastically. After this time, let the fluid run out and repeat the procedure in the opposite ear. If irritation does occur, you can alternate with the use of plain clean drinking water, e.g. 1-day water, 1-day ear beer, 1-day water, 1-day ear beer etc.

Do NOT try to clean/dry your ears after this by using cotton tips: the ear canal is sensitive and easily damaged, even by a cotton tip, especially after this procedure. Also, it does not enhance the preventive effect.

Again, if you even have the SLIGHTEST suspicion of a perforated eardrum, do NOT use ear beer since it can cause severe pain and could potentially damage your hearing bones! What are the symptoms of this? Usually, dizziness/vertigo, slight hearing loss and an unusual hissing (‘pssssshhhhht’ instead of the regular ‘popping’ ) sound when trying to equalize.

Let me know if these measures work for you or not, and if so why. After all, there’s always room for improvement.

Love, Sarah

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