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Through a lip, brightly... This image from One Mile Beach, Forster, yesterday, by Turtle comrade, Steve White. See oceanbeachandcountry.com.au
- Ear infections: Put nothing in your ear smaller than your elbow
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Put nothing in your ear smaller than your elbow
With the water so yukky right now, still recovering from rainfall, floods, etc, we're re-running our story from March 7, 2018, written for us by ocean swimming ENT specialist, Dr Niell Boustred, on care of the ear. It bears attention...
When we were little tacs, our Nan, Chris McKenna (nee Urquhart), taught us some of the basics of life. She taught us, for example, how to eat porridge: by soaking it overnight with a pinch of salt, then covering it with heaps of brown sugar after we'd boiled it up in the morning. It took us half a century to get out of that habit. And she taught us to keep our ears clear of wax by cleaning the ear canal periodically. She did it by sticking a bobby pin inside a hanky and sticking into our ears, twisting it around, and showing us the gunk it found. Now we find that ear wax is our friend, for it helps to protect us from one of the great banes of swimmers everywhere: swimmers' ear. Here, Dr Niell Boustred, an Ear, Nose and Throat Specialist, explains it to us...
Swimmers’ Ear is an infection of the outer part of the ear, fundamentally the ear canal. This is a narrow canal which connects the pinna, the visible part of the ear, with the tympanic membrane, or eardrum.
The medical term for this infection is “otitis externa”. It is distinguished from Surfer’s Ear, which is a narrowing of the ear canal caused by benign bony growths. The bony growths themselves develop as a consequence of exposure to cold water, sand and wind and are common in surfers and ocean swimmers. The narrowing of the ear canal can cause water entrapment which predisposes the surfer or swimmer to otitis externa, Swimmers’ Ear.
What follows is a discussion about the ear canal specifically.
The health of the external auditory canal is maintained by the production of wax (cerumen) in the canal which has antibacterial and antifungal properties. It is acidic and is a superb waterproofing agent. The skin of the ear canal also protects against infection by being migratory, in other words, it moves from the depths of the ear canal to the outer part of the ear canal carrying with it debris (eg.beach sand) from the ear canal itself.
The ear canal has evolved in such a way that it is self-protecting and it is only really when we adversely affect this host defence mechanism that we are likely to develop an episode of otitis externa (Swimmers’ Ear).
Nanna made me do it
We do need to talk about wax, really, before continuing this discussion.
As stated, it is wonderful stuff. It protects the ear canal by waterproofing it. It is full of antibacterial and antifungal agents and has a low pH. Left in place, the wax will do a great job of preventing otitis externa. For reasons that are, frankly, unclear a significant number of the population habitually try to “clean” their ears in the mistaken belief that wax is, in some way, shape or form, dirty. This is not the case. In the overwhelming majority of the population, canals do very well if left completely to their own devices. Again, there are always exceptions to these biological rules, but fundamentally the advice that “nothing smaller than your elbow should enter the external auditory canal” remains a good maxim.
Occasionally, wax blocks the ear canal or prevents an appropriate view of the eardrum and, in that circumstance, it needs to be removed. It can be done safely by an appropriately trained general practitioner with a gentle syringing. The gold standard for cleaning the ear is to use a microscope and a suction. I think any form of personal attempts at cleaning your ear are inappropriate.
Early morning swim. Why do we bother?...
There are a number of factors that are required or may precipitate an infection. We obviously need bacteria or fungi and the skin of the ear canal is a microbe rich environment. These microbes are what we would call commensals. In other words, they are part of the normal microbiology of the skin.
Protracted periods of exposure to moisture may predispose one to an infection but, generally speaking, the precipitating event is a combination of water and trauma to the external auditory canal which classically is produced by earbuds or any form of object, finger, hatpin, wax curettes. In fact, there are fantastically imaginative ways of traumatising the skin of the external auditory canal and therefore precipitating an infection. It is unusual that water exposure per se in an otherwise healthy ear canal would precipitate an infection. Remember the wax etc!
There are certainly patients with chronic skin conditions whose external auditory canals appear to be predisposed to infections, but in the normal healthy individual, water exposure alone is unlikely to precipitate an infection.
Forster: Johnny displays his superiority over the ocean: the only way to master waves is to scare them.
Leave it alone
In those people who are susceptible to infections, particularly precipitated by periods of water exposure, there are three safe ways to dry the external auditory canal.
One is to use Aqua-Ear or Ear Clear, which are mixtures of alcohol and acetic acid (and available widely at chemists). The alcohol acts as an astringent or drying agent and the acetic acid lowers the pH and creates a microbiologically hostile environment.
The use of tissue spears, the corner of a tissue folded and placed in the external auditory canal, will not dislodge wax but will wick moisture out of the ear canal.
Lastly, a hairdryer on a low setting, both in terms of heat and power, can also be used to dry the external auditory canal. Fundamentally this is only required in those people in whom exposure to water may precipitate an otitis externa.
I cannot stress enough the fact that the ear canal is best left to its own devices.
Otitis externa itself is characterized by ear pain and usually develops after a period of water exposure almost inevitably accompanied by some form of simple trauma to the external auditory canal. It can be extremely painful. This is because the skin in the depths of the ear canal is closely adherent to the bone and as the infected ear canal tissue swells, it can become particularly uncomfortable.
The causative organisms in otitis externa are usually bacterial initially, but can be fungal and often, after a protracted period of management with an antibacterial, a fungal infection can develop.
Stormover Diamond Beach (image by Steve White oceanbeachandcountry.com.au)
What to do
Otitis externa needs to be carefully managed. If one develops severe ear pain, particularly if it is exacerbated by simple manipulation of the pinna, I would strongly recommend that you seek the advice of your doctor. Do not attempt to clean the ear canal yourself. I would have a very low threshold for seeking the advice of your general practitioner and, in most circumstances, the infection will respond to relatively simple treatment including the use of appropriate oral antibiotics and particularly appropriate topical antibiotics. Generally speaking these should be initiated only after a swab has been taken. No need to wait for the result, though: initial treatment is empiric. The swab is useful if the condition does not improve.
Careful in the shore break: a shell wedged in the ear canal following a tumble on the edge.
As a specialist, particularly in the summer months in Australia, we see a lot of patients with otitis externa. In some circumstances it can be necessary to clean the ear canal. The gold standard for this is to use a microscope and a suction. We often have to pack the ear canal with appropriate antimicrobial agents because the swelling in the ear canal prevents or limits access of ototopical agents. We would occasionally use a course of oral steroids, commonly appropriate oral antibiotics and very occasionally intravenous antibiotics.
Diabetics can be particularly severely affected in this scenario and require prompt treatment and occasionally hospitalisation with appropriate intravenous antibiotics.
What about ear plugs?
It is not as simple as it may seem
There are certainly patients who appear to develop an otitis externa as soon as the ear canal gets wet and they do appear to benefit from the use of ear plugs. In my opinion, if you are swimming regularly, almost daily, and you are using ear plugs on a regular basis, they could potentially be counterproductive because they prevent the ear canal from cleaning itself, their insertion could be traumatic and they may not be efficient.
This is a discussion that you should have with an Ear, Nose and Throat surgeon and really is only for those people who appear to be getting recurrent episodes of otitis externa. There are no hard and fast rules here. Earplugs do not work for everyone and need to be tailored to your specific needs.
Cerumenolytics, in other words the drops that supposedly dissolve wax, are generally unnecessary and irritating to the ear canal and I do not believe really have a part to play in the day-to-day management of the ear canal.
There certainly is a group of people (swimmers particularly) who have a chronic skin condition and who appear to be predisposed to acute or chronic infections of the ear canal, and I would recommend they seek advice and active management by a specialist. Generally speaking the infections can be controlled if the underlying condition cannot itself be cured.
In conclusion, leave your ears alone, seek advice if there is a problem. If the problem is recurrent or chronic or threatening your swimming career, get the opinion of a specialist.
Dr (R N) Niell Boustred
ENT Specialist, ocean swimmer
Mana Fiji returns in September
It's back to the best ocean swimming water in the Pacific... At last, as things slowly return to normal conditions (ie pre-covid, albeit in a qualified way), we're very pleased to announce the return of the Mana Fiji SwimFest – three days of ocean swimming events in the pristine waters off Mana Island's North Beach, a location that we know as Ocean Swimming Stadium. The SwimFest will run from September 15-17, 2022, with our core travel dates September 13-18.
Mana Island is soon to re-open (at the end of July) after being closed for a couple of years due to covid. They're keen to have us all back, and we're keen to be there. The water off Mana Island, off the north-west coast of Fiji's main island, is some of the best ocean swimming water in the world, not just the Pacific (and we've swum in a lot of places over the years). There will be two swim days, with a 10km swim on Thursday, September 13 (solos and relay teams of three swimmers each), and events of 5km, 2.5km, 1km, and 500m on Saturday, September 15.
This year, Mana Island Resort will run the SwimFest events in co-operation with Fiji Swimming. This means the events will have FINA status.
It's a terrific event for anyone wanting to get away from the colder months and the chocolatey water that we're copping along the coast currently, following the rain and floods. It's also possible to use the Mana 10km event as a qualifying event for the Rottnest Channel Swim. This makes it the ideal event for Rotto qualification, in some of the best water you will ever get.
Our offer to you
Mana Island Resort is offering massive discounts on room rates to those who book through oceanswimsafaris.com: up to 50% off normal rates. We've packaged the core five days together to include your room, swim entries (both swim days), all meals, and return transfers between Nadi International Airport and Mana Island. See our page on oceanswimsafaris.com for more details (link below).
Bonus: Win back the value of your room!
All those who book and pay for their Mana Fiji SwimFest travel package with oceanswimsafaris.com by July 31 will go into a draw to win the value of their room back!
We have packages online now. We're open for bookings, so check out the details quick and smart... Click here
10km swimmers from the last Mana Fiji SwimFest in October, 2019. Even if you don't wish to tackle 10km, you can still take part as part of the 3x3.3 km relay team. (If you don't have a team, we'll find one for you. )
Get your View gogs
World's best gogs at world's best prices
We're continuing our 'never-before' offer of View gogs. The folks at View have adjusted their prices in a small way recently, so we have had to adjust ours correspondingly, but we've kept prices down at sale levels. This keeps them at the world's best value gog (in our experience, which goes on a bit).
Here are some of our bargains…
- View Selene Swipes – $36
- View Wide-eyes Swipes – $36
- View Wide-eyes Swipe Mirrored – $42.50
- View Xtreme semi-masks – $37.50
- Prescription goggles – new Swipe hi-anti-fog models $66.50
Here's the link to order your new gogs. Click now and we'll get them away to you quick and smart… Click here
Not a bad joint for a swim.
2022 Heron Island
Dates open for Oct, Nov
We've begun our 2022 Heron Island oceanswimsafaris. They've been heavily booked, which is immensely gratifying. We appreciate your support enormously. It's also hardly surprising given the quality of the water and the sea life on the Great Barrier Reef itself. It's very different from water around the islands inside the reef.
We're off again to Heron next week, in fact. Our April-May and June oceanswimsafaris to Heron Island are sold out, but we are taking bookings for October 19-24, and November 6-11. There is till plenty of availability in most room standards on these dates.
Best get in quick and smart. It would be good to have you with us.
Find out more and book… Click here
New model Swipes
Prescription gogs now in Swipes
Our Swipes, so far in both Selene and Wide-Eyes versions, have been a big hit, offering what View (the makers) describe as 10 times the anti-fog capacity of other gogs. We've been using them for almost two years now, and we know that it works. We've sold over 1,000 pairs of Swipe gogs since their release just prior to Xmas 2019, so many of you must agree, too.
Now the Platina prescription goggles come in Swipe versions, too. Lenses come in strengths ranging from -1.0 to -10.0, and +1.5 to +6.0, and you can have different strengths in each eye. Just select the strengths you want when you order your gogs online.
View's new Swipe prescription gogs are available at $66.50 a full pair, which is cheap compared with how you will pay at a spectacles shop.
Be aware: View is phasing out the old versions of prescription goggles, currently selling for $A57.85. Some lens strengths are no longer available, and strengths will not be replaced as they run out. Your alternative is to order the new Swipe Optical goggles, which offer 10 times the anti-fog capacity of the older versions.
You can order your new Swipe Optical (prescription) gogs online now… Click here
They're a dour bunch, the Bongin Bongin Dawnbusters, so every now and again, they must bung on promotional days, to keep the punters coming back. Here is one such day, Easter Sundee (one Dawnbuster is a chocolatier)... Glistening Dave image (@glistenrr)
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