Evaluation for waterproof ear protectors in swimmers

An objective comparison of leakage between commonly used earplugs

OBJECTIVE

We sought to determine the efficacy of commonly used earplugs using an anatomically correct ear model.

METHODS

The total volume and rate of water that leaked past the earplug and subsequent defect in the tympanic membrane over separately measured 30, 60, 120, and 180-second intervals were recorded. Scenarios tested included a control with no earplug, custom molded earplug (Precision Laboratories, Orlando, FL), Mack's plug (Warren, MI), Doc's plug (Santa Cruz, CA), and cotton balls coated with petroleum jelly.

RESULTS

All plugs tested resulted in less leakage at all time points when compared with no plug (P < .05). At 30 seconds, the custom molded, Mack's and Doc's plugs all showed significantly less leakage when compared with the cotton ball coated with petroleum jelly (P < .05). At 60, 120, and 180 seconds, Mack's, Doc's, and the cotton plugs all showed significantly less leakage compared with the customized plug (P < .05). At 120 and 180 seconds, Mack's plugs had significant less leakage than the cotton plug (P < .05). Among the types of plugs, the molded variety (Mack's) showed the least volume and lowest leakage rate (f(4,45) = 94 [P < .001]). In addition, Doc's and cotton balls coated with petroleum jelly were more effective than the customized earplugs.

CONCLUSIONS

If the clinician feels that middle ear and external canal water exposure should be minimized, then use of earplugs, particularly the moldable variety, merits further consideration.

Ear problems in swimmers

Acute diffuse otitis externa (swimmer's ear), otomycosis, exostoses, traumatic eardrum perforation, middle ear infection, and barotraumas of the inner ear are common problems in swimmers and people engaged in aqua activities. The most common ear problem in swimmers is acute diffuse otitis externa, with Pseudomonas aeruginosa being the most common pathogen. The symptoms are itching, otalgia, otorrhea, and conductive hearing loss. The treatment includes frequent cleansing of the ear canal, pain control, oral or topical medications, acidification of the ear canal, and control of predisposing factors. Swimming in polluted waters and ear-canal cleaning with cotton-tip applicators should be avoided. Exostoses are usually seen in people who swim in cold water and present with symptoms of accumulated debris, otorrhea and conductive hearing loss. The treatment for exostoses is transmeatal surgical removal of the tumors. Traumatic eardrum perforations may occur during water skiing or scuba diving and present with symptoms of hearing loss, otalgia, otorrhea, tinnitus and vertigo. Tympanoplasty might be needed if the perforations do not heal spontaneously. Patients with chronic otitis media with active drainage should avoid swimming, while patients who have undergone mastoidectomy and who have no cavity problems may swim. For children with ventilation tubes, surface swimming is safe in a clean, chlorinated swimming pool. Sudden sensorineural hearing loss and some degree of vertigo may occur after diving because of rupture of the round or oval window membrane.

An objective evaluation of the waterproofing qualities, ease of insertion and comfort of commonly available earplugs

Earplugs are commonly recommended to protect the middle ear from water in patients with exposed middle ears. This study assessed the waterproofing qualities, ease of insertion and comfort of six commonly available earplugs. Ten subjects (20 ears) were assessed by placing a pre-weighed neurosurgical pattie in their cleaned ear canal under microscope guidance. The subjects underwent a standardized head wetting regime. The outer ear was dried, earplug and pattie removed and pattie reweighed. The difference in weight was calculated. The subjects were also asked to score the difficulty of insertion and comfort of the earplugs on a visual analogue scale. The results show a significant difference in the waterproofing qualities of the various types of earplugs. Cotton wool with petroleum jelly was the most effective (P < 0.001). It was also the easiest to insert and the most comfortable for the subject (P < 0.001).

Long-term results of Goode's tympanostomy tubes in children

The results of a retrospective study of the complications of middle ear ventilation by Goode's T-tubes in children are presented. 248 T-tubes were inserted into 119 patients. 16.9% progressed to spontaneous extrusion with a mean period of ventilation approaching 20 months. 54.9% of patients experienced otorrhoea which was found to be significantly more common in those ears with a mucoid effusion at the time of T-tube insertion. 21.1% of ears developed a persistent perforation where spontaneous extrusion had occurred or the T-tubes had been removed. Perforation also occurred more frequently in those with otorrhoea.

The Dansac mini cap: a new method of waterproof ear protection

The best method of providing waterproof protection for susceptible ears remains a contentious issue. Many evaluations have concentrated on the efficacy of intraluminal plugs in normal or model ears. We describe a new method, using a jejunostomy shower cap (Dansac mini cap), which avoids intraluminal insertion. This method has proved useful in some patients who have failed to avoid repeated otorrhoea after water exposure despite using a wide range of intraluminal ear plugs. The shower caps are best avoided in children because of teasing.