Patient Education

Otitis externa, better known as swimmers’ ear, is a common summertime ear infection. This infection is found in the outer ear, the portion of the ear canal that runs from the eardrum to outside the head. Swimmer’s ear is not the same as inner ear infection, which is also common in children.

Causes

Water left in ear canal from swimming pools, lakes and bathing are some of the most common causes of swimmer’s ear. Contaminated water carrying bacteria enters the ear, and since bacteria need a moist place to grow, the ear is an ideal environment for swimmers’ ear to thrive.

Your ear has natural defenses to prevent infection such as earwax, which accumulates dead skin cells and other debris that travels to the opening of the ear to keep it clean, a thin slightly acid watery substance that discourages bacterial growth lines the ear canal, and the small opening to the outside of the ear helps prevent foreign objects from entering the ear.

The inner ear canal has a thin layer of protective skin that can be injured by using cotton swabs, hairpins or fingernails inserted in the ear. This can lead to bacterial invasion and subsequent infection. Ear devices, such as earbuds or hearing aids, which can cause tiny breaks in the skin, can also leave the ear susceptible to bacterial invasion.

Symptoms

Symptoms are classified as mild, moderate, and advanced

Mild symptoms include redness and slight itching in the ear canal, drainage of clear odorless fluid.

Moderate symptoms include pain in ear canal, more extensive redness in the ear, feeling of fullness inside your ear, decreased or muffled hearing and excessive fluid drainage.

Advanced symptoms include redness or swelling of the outer earn fever, swelling of the lymph nodes in the neck, severe pain radiating to the face, neck, or side of head and complete blockage of ear canal.

Complications

Swimmer’s ear isn’t usually serious if treated promptly. There are some serious complications that can arise if left untreated such as:

• Temporary hearing loss- muffled hearing until infection clears
• Deep tissue infection (cellulitis) (Rare)
• Also, rare but life threatening is bone and cartilage osteomyelitis. This is an in infection of the bone and surrounding cartilage. The infection can spread to the brain and surrounding nerves. This complication is more likely to be found in the older population and diabetic patients.
• Long-term infection (chronic otitis externa). An outer ear infection is usually considered chronic if signs and symptoms persist for more than three months. Chronic infections are more common if there are conditions that make treatment difficult, such as a rare strain of bacteria, an allergic skin reaction, an allergic reaction to antibiotic eardrops, a skin condition such as dermatitis or psoriasis, or a combination of a bacterial and a fungal infection.

Prevention

To avoid swimmer’s ear, keep ears as dry as possible and:

• Use a bathing cap, ear plugs, or custom-fitted swim molds when swimming.
• Use a towel to dry ears well.
• Tilt head back and forth so that each ear faces down to allow water to escape the ear canal.
• Pull earlobe in different directions when ear faces down to help water drain out.
• If there is still water in the ear, consider using a hair dryer to move air within the ear canal.
• Put the hair dryer on the lowest heat and speed/fan setting and hold the hair dryer several inches from ear.
• Swim wisely. Don’t swim in lakes or rivers on days when warnings of high bacteria counts are posted.

Treatment

• Check with your healthcare provider about using ear-drying drops after swimming.
• DON’T use these drops if you have ear tubes, punctured ear drums, swimmer’s ear, or ear drainage.
• DON’T put objects in ear canal (including cotton-tip swabs, pencils, paperclips, or keys).
• DON’T try to remove ear wax. Ear wax helps protect the ear canal from infection.
• If you think the ear canal could be blocked by ear wax, check with your healthcare provider.
• They may recommend an in-home earwax removal kit or have you come in to have the earwax removed.
• You may be prescribed antibiotic ear drops to kill the invasive bacteria or anti-fungal eardrops to combat the infections and steroids to help reduce swelling.

Are you planning a trip but are prone to motion sickness?

Motion sickness can make a much-anticipated trip downright miserable. If you or your loved one are prone to motion sickness, there are some strategies and effective medications that can help alleviate the symptoms.

What causes motion sickness and what are the symptoms?

Motion sickness happens when the movement you see is different from what your inner ear senses. It is a complex series of stimuli between your brain, eye and even your skin that is receiving different signals about what is going on in your environment.

Who is most vulnerable to motion sickness?

• Children between ages 2 and 12 are the most vulnerable to motion sickness, however almost everyone has experienced motion sickness at some point in their lives.
• Pregnancy
• Persons with acoustic neuromas (tumor on balance nerve of the ear)
• Women are more likely than men to get motion sickness. It is suspected that estrogen may play a part in increase of nausea when the hormone spikes.

Symptoms include:

• Nausea
• Vomiting
• Pale, clammy skin
• Excessive salivation
• Apathy
• Hyperventilation
• Increased sensitivity to odors
• Loss of appetite
• Headache
• Drowsiness

Prevention

Some non-pharmacologic interventions to prevent motion sickness are:

• Eat a light meal, no fatty or heavy foods before travel.
• Limit caffeine and alcohol intake, both can cause dehydration
• Stay well hydrated, sip on water during the trip
• To help reduce motion or motion perception be the driver and not the rider
• Avoid reading while in a moving vehicle
• Sit up front if the passenger in the car or bus
• Sit over the wing of the airplane to reduce motion perception
• Practice deep breathing exercises, this helps give you mind a focal point and off the motion of the vehicle
• Close eyes, sleep or try focusing on the horizon
• Aromatherapy such as mint or lavender may help take the edge off or prevent nausea
• Some people have had limited success with acupressure points to prevent or reduce motion sickness symptoms. These points are located 3 finger widths down from the wrist. However, this has had limited and anecdotal success.

Medications

There are several over the counter and prescription medications that can alleviate motion sickness. Listed below are some of the most common over the counter and prescription medications that have been proven to be effective treatment for preventing or treating motion sickness.

Antihistamines are the most common medication used to treat motion sickness, however there are other medicines that are highly effective. The non-sedating forms of antihistamines are not effective when dealing with motion sickness.

Note: Children under the age of 12 should not take any medications even over-the-counter antihistamines- which are effective in treating motion sickness- such as Benadryl and Dramamine (ages 2-12) and Bonine (Age 6 and up) without consulting their primary care provider.

For adults the following medications are recommended for motion sickness: (click on the hyperlink for more extensive information) Also, all the following medications advise avoiding alcohol while using.

As with all medications (motion sickness and others) if you have any side effects such as difficulty breathing, swelling of the face, lips tongue or throat, rashes, hives, heart irregularities, or difficulty urinating seek medical attention immediately.

Anticholinergic antiemetics

• Scopolamine transdermal (prescription)

The scopolamine patch is a highly effective motion sickness patch that is applied behind the ear four or more hours before travel and is effective for up to 3 days. It is used for adults and not indicated for use in children. Care should be taken applying and removing the patch and avoid contact with eyes after handling it. The medication can cause temporary blurred vision if it gets into the eyes. Avoid driving, water sports, or operating machinery until you know how scopolamine transdermal will affect you. Some side effects are feeling drowsy or disoriented, irritable, dry mouth and sore throat. Some medicines, such as antihistamines can worsen the drowsiness. Be sure to inform your care provider of the other medications, both prescription and over the counter that you are using especially antidepressants, medicines to treat Parkinsons, bronchodilator (asthma) and overactive bladder medicines to name a few. Also let your provider know if you are or suspect you are pregnant or nursing history of kidney, liver, enlarged prostate, seizures, mental illness, a blockage in your digestive tract (stomach or intestines) or breathing disorders before using.

Antihistamines

• Dimenhydrinate (Dramamine) (over the counter)

Dramamine is a popular anti-nausea medication. Take 30-60 minutes before travel. May cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Side effects include dry mouth, constipation, blurred vision, and excitability in children. Consult your primary care provider if before taking dimenhydrinate with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Also let your provider know if you are or suspect you are pregnant, history of kidney, liver, enlarged prostate, stomach or intestinal blockage, hyperthyroid, seizures, or breathing disorders before using.

• Promethazine (oral and suppository) (Phenergan) (prescription)

Promethazine is in the antihistamine and Phenothiazine antiemetics classes. It has the advantage of being in both pill and suppository form in case the motion sickness is severe and unable to tolerate anything by mouth the suppository can be used. For motion sickness use 1 hour before travel. It is a popular medication with many uses- as a sleep aid, post-surgery nausea and vomiting, allergy symptoms such as itchy skin rashes and hives along with motion sickness.  This drug can impair decision making and cause drowsiness. There are many other medicines that can interact with promethazine. Be sure to review your health history before deciding to use this medication especially if you have a history of seizures, asthma, COPD, sulfite allergy, and heart or liver disease to name a few.

• Meclizine (Bonine, Antivert) (over the counter)

Meclizine is another popular motion sickness medicine that is supposed to cause less drowsiness than Dramamine. However, some claim it is not as effective at curbing the nausea caused by motion sickness. To prevent motion sickness, take meclizine about 1 hour before you travel or engage in activity that causes motion sickness. You may take a dose once every 24 hours while you are traveling, to further prevent motion sickness. Some side effects are headache, vomiting, dry mouth, tiredness, and drowsiness. Do not give to children under the age of 12. Before taking meclizine talk with your care provider if you are using sleeping pills, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures. Also, if you have liver, kidney, glaucoma, prostate, difficulty urinating or asthma consult your care provider before using.

• Cyclizine (over the counter)

Cyclizine is an antihistamine that is used to treat nausea and vomiting caused by motion sickness. It is taken at least 1 hour before travel and should only be given to persons over age 6. This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Some side effects are blurred vision, constipation, dry mouth, and dizziness. Let your care provider know if you have a history of glaucoma, liver or kidney disease, lung or breathing problems, pregnant, stomach or prostate conditions.

Before taking cyclizine with sleeping pills, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures consult with your care provider

With a little planning and armed with preventative measures and medications you can arrive at your destination without suffering the effects of motion sickness.

As the dog days of summer continue throughout much of the country, with many regions experiencing record or near record heat, it is easy to forget about the dangers that excessive heat can have on the body.  I recently had an experience that brought this to light that stresses the importance of being aware of the heat and keeping yourself hydrated and cool. I noted the excessive heat warning for our area was expected to reach over 112 in our area for the entire week.

We have a golden retriever who needs his daily exercise, which includes several visits to the local dog park each week.  Since it was going to be too hot to go at our usual time(1pm) I took him early- 8 am and stayed until 9:30 am. He played in the shallow pool they provide at the park while I sat in the shade under a bench. Before we left, I decided to talk a walk around the perimeter of the park, a hilly 5-acre plot of land. This is something I usually do when we visit the park.  By then the temperature had reached 95 degrees, I felt hot and could tell the heat was affecting me. We loaded up in the hot car and drove home.

The rest of the day I felt slightly nauseated, dizzy and had a throbbing headache. Later that day I went out to dinner with my husband. As we were waiting for our food I drank a large glass of iced water, then another. Then 2 glasses of iced tea. By the time our food arrived my nausea and headache had disappeared.  I felt better the rest of the evening. I had experienced mild heat exhaustion and slight dehydration and hadn’t realized it.

Most people think of heat related illnesses in the most susceptible group, infants and elderly. These two groups can have undeveloped or an impaired ability to thermoregulate in extreme temperatures. Which can make the susceptible.

1. Not being acclimated to the Heat

Air conditioning is a luxury that our ancestors didn’t have. Going from very cool temperatures to the outdoors where the temperatures are reaching triple digits can throw off our body’s thermal regulation.

2. Medications

Especially diuretics, which are designed to remove fluid from the body, can set one up for dehydration and subsequent heat exhaustion in a hurry. Other medications that can cause dehydration and subsequent heat exhaustion are antihistamines, beta blockers, antipsychotics, and tranquilizers. There are some drugs that can increase your body temperature such as Adderall and Ritalin. Illegal stimulants which include cocaine, ecstasy and methamphetamine are among the most common drugs that can raise your body core temperature.

3. A High Heat Index

The heat index is a single temperature value that considers how both the outdoor temperature and humidity make you feel. When the humidity is high, your sweat can’t evaporate as easily and your body has more difficulty cooling itself, making you prone to heat exhaustion and heatstroke. When the heat index is 91 F (33 C) or higher, you should take precautions to keep cool.

4. Obesity

Body fat acts like an insulator, somewhat akin to wearing a large coat in the heat.

5. Caffeine Consumption

Caffeine is a mild diuretic and can set you up for heat related problems.

6. High Humidity

Your body has difficulty cooling itself when the humidity is high since sweat isn’t able evaporate and cool your body.

The CDC has an excellent graphic of heat related illnesses- and what to do if you are experiencing symptoms:

Take precautions

Heat exhaustion can easily turn into heat stroke and become a medical emergency if steps aren’t taken to relieve symptoms and to move to a cooler climate. Heat stroke is a life-threatening emergency and immediate medical attention is essential. (see above graphic for symptoms)

Taking a few precautions can alleviate either of these heat related illnesses

• Check with your local weather forecast where you will be spending time outside. Try to avoid being out in the heat of the day if possible.
• Remember to pack water and sun protective hat if you plan on being outside during the heat of the day- usually between 10am -2pm. However, when an extreme heat advisory is issued, check the hourly temperature and humidity index.
• Plan exercise during the coolest parts of the day and ace yourself.
• Protect against sunburn- Sunscreen and protective, lightweight clothing, and avoiding the sun-Sunburn affects the body’s ability to cool itself.
• Check your medications- there are many medications that can raise your body temperature or can make you heat/sun sensitive
• Never leave anyone in a parked car, especially children and pets. Last year 23 children died in hot cars, Parked cars have been demonstrated to heat from 80 degrees to 123 degrees in 60 minutes.( in just 2 minutes the temperature went from 80 degrees to 94 degrees)
• Choose lightweight, breathable clothing to wear in the heat
• If you or anyone you are with starts showing signs of heat related illnesses get yourself or them into a cool building and treat appropriately or seek medical attention.