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Chapter 28 — 2
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Treatment.
All coral cuts should be washed with bleach or soapy water as soon as possible and the surface of the
cut or abrasion should be thoroughly cleaned. This removes foreign material that may be the source
of inflammation. All cuts should then have local antibiotic powder, cream or ointment applied every
6 hours until healed. The senior (elderly) author, who has a tendency towards cowardice, relies more
on the antibiotics than vigorous cleansing. Suitable topical antibiotics include neomycin or
bacitracin.
Early attention to every coral cut in this way will usually prevent serious infections. If treatment is
delayed, or if systemic effects occur, oral broad-spectrum antibiotics may be needed. The
development of a chronic inflammation may cause severe itching over the next few weeks, but this
usually responds to local steroid (cortisone) ointments.
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Prevention.
It is wise when diving on coral reefs to always wear protective clothing or a wet suit, gloves and
booties. Modern lightweight "lycra suits" afford some protection and may be worn in very warm
tropical waters. These provide no flotation or thermal insulation properties, and diving must be
adjusted for this.
EAR INFECTIONS
Otitis Externa
(Swimmer's or Tropical Ear")
This outer ear infection is one of the most common and troublesome problems in divers. It is
especially likely to occur in
hot
humid
conditions
(e.g. tropical climates, standard diving dress,
compression chambers) or when
water
is retained
within the ear after immersion, especially if with
contaminated water
. Small bony outgrowths (
exostoses
) are commonly found in the ears of
swimmers and divers, and these may be large enough to cause retention of water, wax, debris and
organisms.
Local injury
induced by scratching the ear canals (with a match or hair pin), or by
clumsy attempts to remove
wax
(often using cotton buds) frequently precipitates the infection.
Sometimes an underlying
skin disorder
is present such as eczema or dandruff. Many bacterial
organisms have been incriminated, as well as fungi.
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Clinical features.
Mild
infection
causes
itching
of the ear which encourages the diver to scratch the ear canal, further
breaking down the protective barrier and aggravating the infection. This has prompted the good
advice that “nothing smaller than your elbow” should be inserted into the ear canal.
Serious
infection
may appear as a local boil in the ear canal, or as a diffuse inflammation with
narrowing of the canal and an offensive smelling discharge.
Pain
with movement of the jaws or
pulling on the ear is common. Occasionally a
mild hearing loss
or
dull feeling
in the ear may be
noticed, and
dizziness
during diving is a possibility if one canal is completely blocked.