sewage keeps falling on my head

Steve,

Has anything been cultured from your sinuses? That would dictate antibiotic choice if the routine ones don't work.

Have you spoken to Frans Cronje of DAN, South Africa? He really is the guy to talk to about diving related ear and sinus stuff in my opinion.

I'm also looking for a pic I have somewhere of Mauricio Handler swimming through caca just dumped off the rig at Mabul a few years ago.

Jeff - Would love to see your caca picture!

Thanks also for thought about Dr. Cronje. Coincidentally, we did talk about it when he was in Durham for a while over the summer. I'm comfortable with the next step and have a very talented ENT now on the case, also as DAN referral.

Please send the photo along if you can find it, Jeff. Especially if you have prominent "brown stinkers" (homage to Drew's colorful descriptive).

I would like to make a few points in this blog.

I would suggest isopropyl alcohol and white vinegar ear canal irrigation rather than tap water. The acidic mix of alcohol and vinegar approaches the normal protective acidic pH of the external ear canal. This mixture is better for the ear than tap water. The purity and pH of tap water in Lembeh Staits is questionable. Alcohol/vinegar drops are often used as a first line treatment for an external ear canal infection.

If infectious sinusitis has been present for 5 months and treated with the correct antibiotics (type and duration) then there is a mechanical or drainage problem. Surgical drainage is indicated.

Elmer

If infectious sinusitis has been present for 5 months and treated with the correct antibiotics (type and duration) then there is a mechanical or drainage problem. Surgical drainage is indicated.

 

Elmer

Agree fully that this is the standard approach; though one would expect at least temporary response to antibiotic therapy. There are atypical cases of sinusitus, though quite rare.

I think the question being presented in this thread is whether this is just a typical sinusitus that could happen anywhere or is it related to swimming in contaminated water. The bacteria normally related to sinusitus are very different to those found in fecally or otherwise contaminated water. I just wonder whether guys like Frans Cronje have ever seen atypical cases of sinusitus related to diving in contaminated water.

Agree fully that this is the standard approach; though one would expect at least temporary response to antibiotic therapy. There are atypical cases of sinusitus, though quite rare.

I think the question being presented in this thread is whether this is just a typical sinusitus that could happen anywhere or is it related to swimming in contaminated water. The bacteria normally related to sinusitus are very different to those found in fecally or otherwise contaminated water. I just wonder whether guys like Frans Cronje have ever seen atypical cases of sinusitus related to diving in contaminated water.

Jeff,

The point I am making is that Stephen Frink's sinus should be drained, assuming that he was treated with the correct antibiotic for an adequate amount and duration of treatment. This is irregardless of what organism is present as long as it is sensitive to the medication that was prescribed.

Since we do not know what is growing in Mr Frink's sinus, I don't believe we can comment on the etiology of his infection.

Regarding if contaminated water can cause a sinusitis, I would say yes it is possible. But you know that in general the vast majority of sinus infections are secondary to normal nasal flora like strep and H flu and fungal infections are associated with allergic sinusitis.

Elmer

Jeff,

 

The point I am making is that Stephen Frink's sinus should be drained, assuming that he was treated with the correct antibiotic for an adequate amount and duration of treatment. This is irregardless of what organism is present as long as it is sensitive to the medication that was prescribed.

 

Since we do not know what is growing in Mr Frink's sinus, I don't believe we can comment on the etiology of his infection.

 

Regarding if contaminated water can cause a sinusitis, I would say yes it is possible. But you know that in general the vast majority of sinus infections are secondary to normal nasal flora like strep and H flu and fungal infections are associated with allergic sinusitis.

 

Elmer

Elmer,

I'm not disagreeing with you about the standard treatment for sinus infections and whether Steve's sinus should be drained or not, but this thread is about diving in contaminated water and whether it is related in this case by implication to health hazards such as Steve's sinus infection.

To quote Steve "The issue I'm trying to research is one of ultra-poor water quality that might ultimately impact health ... ears, sinuses, gastrointestinal, etc. Let me rephrase then. Has anyone had health issues that they might think are directly attributable to poor water quality in some of the remote regions of the world where we choose to dive?"

I would submit that the only way to make a connection between contaminated water and infections is to connect the organisms in the contaminated water and the suspected infections. In this case,to make a connection between Steve's sinus infection and contaminated water, one would have to culture some atypical organism possibly found in contaminated water, and not one of the normal flora implicated in sinus infections. Simple example of Koch's postulates in practice.

And as you say we do not know what is growing in Steve's sinus, so my comment is that if we want to know, and if we want to see if it is possibly related to contaminated water, culture it!

Elmer,

I'm not disagreeing with you about the standard treatment for sinus infections and whether Steve's sinus should be drained or not, but this thread is about diving in contaminated water and whether it is related in this case by implication to health hazards such as Steve's sinus infection.

To quote Steve "The issue I'm trying to research is one of ultra-poor water quality that might ultimately impact health ... ears, sinuses, gastrointestinal, etc. Let me rephrase then. Has anyone had health issues that they might think are directly attributable to poor water quality in some of the remote regions of the world where we choose to dive?"

I would submit that the only way to make a connection between contaminated water and infections is to connect the organisms in the contaminated water and the suspected infections. In this case,to make a connection between Steve's sinus infection and contaminated water, one would have to culture some atypical organism possibly found in contaminated water, and not one of the normal flora implicated in sinus infections. Simple example of Koch's postulates in practice.

And as you say we do not know what is growing in Steve's sinus, so my comment is that if we want to know, and if we want to see if it is possibly related to contaminated water, culture it!

Thanks Jeff. My ENT is fully intending to culture. Since I have to receive the surgery anyway, I don't want to miss the opportunity to have it possibly contribute useful research.

I like the prevention vs. cure approach too.

FWIW, a couple Indo trips ago, I found Otopain ear drops. They seem readily available at many Indo pharmacies and contains "Polymyxin B sulfate, Neomycin sulfate, Fludrocortisone acetate, and Lidocaine HCI". Not that I would encourage anyone to take medications without checking with their physician ( ), but antibiotics, anti-swelling and pain relief all in one package may help until you can get to the "real" doctor. I carry it with me in addition to the alcohol/vinegar mix just in case. I'd be interested in hearing (!) any opinions from those with greater knowledge as to whether using these drops if you get something nasty while traveling is worthwhile.

Phil

My impetus to comment directly regarding Mike Veitch’s ears and Stephen Frink’s sinsus was to intervene in their suffering. Both have painful conditions that are correctable with proper treatment.

In the former, otitis externa, there is a direct relationship between water entry into the external ear canal and infection. The mechanism of action is the physical removal of the protective ear wax and change in pH that allows bacteria and fungal growth.

In the later, sinusitis, the relationship to diving is more ambiguous since there should be no direct contact between the sinus cavities and the water. But trauma, inflammation or anatomical abnormality could provide an avenue for water entry. A culture will provide us with useful information regarding the etiology.

Another point I should mention is that all waters that we dive in are contaminated with microorganisms. The difference between swimming pools, lakes, rivers and of course the ocean can only be quantified by culture and cell counts. So take care of your ears, do not inhale or swallow the water.

Elmer

I like the prevention vs. cure approach too.

 

FWIW, a couple Indo trips ago, I found Otopain ear drops. They seem readily available at many Indo pharmacies and contains "Polymyxin B sulfate, Neomycin sulfate, Fludrocortisone acetate, and Lidocaine HCI". Not that I would encourage anyone to take medications without checking with their physician ( ), but antibiotics, anti-swelling and pain relief all in one package may help until you can get to the "real" doctor. I carry it with me in addition to the alcohol/vinegar mix just in case. I'd be interested in hearing (!) any opinions from those with greater knowledge as to whether using these drops if you get something nasty while traveling is worthwhile.

 

Phil

Phil,

This medication should treat an external ear canal infection. But you should be aware that otic (ear) preparations can break down when exposed to tropical temperatures and that it is not uncommon to develop a contact dermatitis from neomycin/polymyxin sulfate mixture.

Elmer