To Ear Plug or Not to Ear Plug

Seems like a fairly simple question... but oh what controversy it stirs up when regarding a patient with ear tubes who wants to go swimming.

There are two schools of thought...

1) Based on evidence and research, no need to wear ear plugs... ever.

The argument... Well, here's the research:

• A meta-analysis of swimming and water precautions.
• Water precautions and tympanostomy tubes: a randomized, controlled trial.
• A meta-analysis of swimming and water precautions.
• The effect of water exposure after tympanostomy tube insertion. 

 2) Based on personal experience, ear plugs should be worn.

The argument:

When there's a tube present through the eardrum, any water that gets into the ear canal can potentially go through the tube and into the middle ear space and cause an infection (otitis media). The middle ear space should remain sterile, but if the water is contaminated with germs, this sterile space becomes violated.

Remember, germs found in swimming pools, lakes, rivers, and oceans can be quite funky to say the least. Think of all the birds and animals that go potty in such bodies of water (let alone humans).

Furthermore, there is a type of ear infection called Swimmer's Ear (otitis externa) which is an infection of the skin lining the ear canal. If swimming can cause Swimmer's Ear, than by golly, it certainly can cause middle ear infections as well.

Also, if swimming can cause life-threatening brain eating amoebic infections (amoeba travels into the nose and up into the brain), than by golly, such water getting into the ear can certainly cause ear infections.

Though research does not necessarily bear this argument out, many ENTs have noted from personal experience that it is not uncommon that a patient with ear tubes presents with a draining ear infection within a few days of swimming.

Given water precautions take minimal effort and costs little ($10 ear plugs or swim cap or ear bands... see below), it seems worth it to play it on safe side.

Conclusion?

What do I typically recommend? Ear plugs when swimming, but not necessary when taking a bath (given tap water is theoretically clean).

Many will disagree depending on who you ask, but that's my personal opinion.

Amoeba Deaths from Neti-Pot Use and How to Minimize Risk

In the past few weeks, there have been numerous stories about the 2nd death in Louisiana from Neti-Pot use leading to an amoeba infection of the brain. The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.

As such, recommendations have been issued to use water as instructed with the Neti-Pot packaging... water should be boiled, distilled, or filtered.

However, before the millions of people who may have elected to simply use tap-water change their daily routine, consider that more commonly, swimming in warm lakes or rivers causes 2-3 amoeba related deaths per year... and swimming in and of itself leads to thousands of drownings per year. So far, there have been only TWO amoeba-related deaths linked with Neti-Pot usage that we know of so far.

In any case, lets talk about boiled, distilled, or filtered water and what a Neti-Pot user can do to keep their daily routine simple. After all, it is so simple to simply fill the container with running tap-water. The additional step to keep things safe can become annoying.

Boiled Water: Naegleria fowleri can not survive in temperatures above 47°C. As such, by boiling water, you guarantee death if any are present in the water.

Save time by boiling a large amount of water and storing in 1+ gallon containers for daily use.

Distilled Water: By definition, distillation involves boiling the water and then condensing the steam into a clean container. It's a slow process, but it not only kills any micro-organisms much like simple boiling does, but also removes any inorganic "impurities" that may be harmful like mercury as well as beneficial minerals including calcium, magnesium, and sodium. Distillation does not discriminate.

It is not feasible for most individuals to set up a home water distillation process just so they can use the Neti-Pot. Though can get expensive over the years, save time by purchasing large volumes of distilled water to have at home. But, there are portable water distilling machines you can purchase as well.

Filtered Water: Water that is filtered is cleaned by means of a fine physical barrier, a chemical process or a biological process. In most homes, filtered water is almost universally achieved by a physical barrier. There are numerous vendors out there that sell devices to filter the water including Pur Water and Brita.

Save time by purchasing a faucet attachment that automatically filters water into your Neti-Pot when you need it.

How Long Can You Survive Without Water or Food???

Well, according to a New Scientist article, with at least a supply of vitamins and water, you can survive over a year without eating. However, with vitamins but no water, survival time is sharply reduced.

"A human can be expected to survive for weeks without food, but a thirsty person deprived of water would last a matter of days. Without water, the volume of blood in your body drops, and with it your blood pressure. Blood becomes thicker and stickier, making it harder to pump around the body, so your heart rate increases to compensate. Even in a cool environment, you wouldn't last for more than a week without water."

Vitamins are necessary along with water as vitamins allow the body to metabolize fat storage. Otherwise, accumulated adipose tissue can't be utilized for energy.

Read the full article here.