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Treating swimmer's ear and getting to the bottom of Bell's palsy

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Dr Nina Byrnes

Dr Nina Byrnes

Dr Nina Byrnes

I have recently taken up swimming. I did it to improve my health and I am getting fitter. The problem is I now suffer with pain in my ear that I never had before. I have been given a course of antibiotic drops but it keeps coming back. Do I need to stop swimming or is there anything I can do?

A: Those who swim a lot are more prone to infections of the ear canal. The official name for this condition is otitis externa (OE) but it is commonly called swimmer's ear. The ear canal is the part of the ear that runs from the outside of the head to the eardrum. OE occurs along this path.

The main symptom of OE is pain. This may vary from mild to severe but usually progresses over a number of days. Other symptoms can include itching, ringing in the ear, a feeling of fullness or reduced hearing, and discharge. Rarely in severe cases there may be fever, redness of the ear and face, or swelling of the lymph nodes in the neck.

The outer ear normally protects itself by producing cerumen (wax). This is slightly acidic thus limiting the growth of bacteria and fungus. This substance also traps dirt and debris and helps clear it from the ear canal by moving it to the outer part of the ear. OE is more common when the natural barriers in the ear canal are disrupted. This can occur when water is trapped in the ear canal. Thus OE is more common in those who take part in water sports. Water can get trapped in the ear when showering and the passage of shampoo into the ear canal can further disrupt the natural pH. Humid weather also increases ear moisture and can increase the risk.

Over-zealous cleaning of the ear using cotton buds, or hair grips can damage the skin lining the ear canal making infection more likely. The use of ear plugs, headphones and hearing aids is associated with an increased risk. Lastly conditions that irritate or inflame the skin of the ear such as dermatitis and psoriasis can also lead to otitis externa.

Infection is due to a bacterial infection in the majority of cases. More rarely fungus, allergies or inflammation may be the cause. OE can affect all ages. It occurs all over the world but may be more common in tropical or humid climates.Those who have a narrow ear canal may be more prone to obstruction and infection.

A simple trip to the doctor should allow diagnosis and treatment of most cases. In OE the pain in the ear is made worse by pressing on the area just in front of the ear or pulling on the ear lobe. Your doctor may swab the ear to identify the bacteria causing the infection. Ear drops are normally prescribed and work well in most cases. These may contain a combination of an antibiotic, steroid and anti-fungal medicine. Infections normally resolve over five to seven days.

The best way to prevent OE is to avoid placing foreign bodies (including cotton buds) into the ears and to keep them as dry as possible. When swimming or showering place some cotton wool with a smear of petroleum jelly on the outside into the ear to prevent water entering. If your ears do get wet gently dry the outside with a towel. Tilt the head sideways to allow any excess water to drain and consider drying the ear by putting a hair-dryer on low and drying the ear gently from a distance.

For those with recurrent infections keeping the ear acidic can help. There are some drops available that contain acetic acid and rubbing alcohol in a specific ratio. However always talk to your doctor first as it is essential to ensure that the eardrum hasn't been damaged before using these.

Bell's palsy

My husband lost power on one side of his face recently. We thought he was having a stroke and rushed to the hospital but we were told this is Bell's palsy. It seems to be improving a bit. What is this and how long will it last?

A: Bell's palsy is a condition which causes weakness of the side of the face. This results in drooping of the muscles on one side of the face and forehead. Smiles appear one-sided and the eye may not close properly on the affected side. Some people also experience dizziness, ringing in the ears and altered taste with difficulty eating food.

The exact cause of Bell's palsy is unknown. The symptoms are due to weakness or inflammation of the facial nerve.This may occur due to a viral upper respiratory infection. Other associations include the cold sore virus and more rarely other viral illness or Lyme disease.

Facial weakness may progress from mild to severe over a few hours. Many people do worry they are having a stroke but thankfully this is not the case. The nerve damage in Bell's palsy occurs outside the brain whereas in a stroke the damage is in the brain. If the forehead is weak on the same side as the facial droop then Bell's palsy is the most likely cause. In the case of a stroke weakness of the forehead is not usual.

Most cases of Bell's palsy resolve themselves with time. The main weakness usually improves over about two weeks. Residual weakness may take a few months. Rarely prolonged facial weakness will remain. Steroid medicine may help reduce inflammation to the nerve and can help in some people. Antiviral medicine may also be prescribed if it is suspected that the cold sore virus is involved.

It is important to protect the eye. The eye can become dry and irritated as it is unable to close fully. Use regular lubricating drops and apply a patch to the eye to protect the eye surface. A physiotherapist may prescribe specific facial exercises and massage techniques that help support facial muscle strength.

 

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