Thursday, 17 January 2008

Bosnian Ear Aches

Being hospitalised when overseas is always difficult. But being hospitalised in a building fresh with bullet and shell holes from a war only a few years ago, where the signs are in Cyrillic, and where patients are literally spilling out from the doors, is something different altogether. I've had the pleasure of Hong Kong and Indian hospitals, but the Bosnian hospital was not only unexpected, but unexpectedly pleasurable.

Not only were the Mostar hospital staff friendly in tolerating my lack of local language skills, but the owner of the hotel in which we were staying escorted me to a local doctor and translated, and then took the specialist referral form from the doctor, with me in tow, to the hospital, negotiated our way through the masses of people following signs I could not read to the audiology specialist, where she again translated for me. She even helped me out with some KM as I only had Euro! As was the case in Hong Kong and India, the specialist was brilliant and spoke better English than me.

So, to the science of the problem. Once again I found myself with an ear infection - most likely from swimming in Dubrovnik. Otitis externa is an inflammation of the ear canal and outer ear, and something that some people, like myself, are sensitive to. For me, it came with total deafness in my right ear, and some blood. It can be a mixture of fungal and bacterial infection that attacks the skin after it has had some trauma - perhaps you cleaned your ear with a cotton bud, which you should never do.

Otitis externa usually begins with an itchy ear, after which pain and deafness can follow. The deafness may be caused by wax covering the eardrum, or in bad cases, from the external ear swelling so much that the ear cavity completely shuts. This is a dreadfully painful experience and did not happen to me this time, but has in the past. Often there is some discharge from the ear, often foul-smelling - in my case blood from the aggravated outer ear. I had tried some over-the-counter medication to dry up the wax, but that can worsen swelling if you have an infection.

I was prescribed something that was written in Cyrillic, so I didn't actually know what it was. However, a few questions and a little research led me to the following ingredients:

Dexamethasone is a corticosteroid that is used for reducing inflammation. Corticosteroids are naturally produced in the body by the adrenal gland, and dexamethasone is a synthetic adrenal corticosteroid. Inflammation can be caused by infection and is an attempt by the body to remove the injurious stimuli and start the tissue healing.

Neomycin is a aminoglycoside antibody. Such antibiotics are broad-spectrum, and so can defeat a wide variety of bacteria by binding to the bacterial cell and producing abnormal proteins. Such proteins can not keep the bacteria alive.

Acetic acid makes the ear acidic, which is difficult for the bacteria to survive in.

So there you go, more health problems that you can experience whilst travelling!

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For more information, see netdoctor


  1. From a friend Cath (ear specialist!)....

    Hi Marc - love your information about otitis externa. Thanks. My housemates in the Philippines succumbed to it while I was there. They often call it "swimmer's ear", because it's common to get it if you've been swimming in water that contains bacteria. It seemed to be pretty painful, so I hope you're well and truly over it now. We actually did an awareness campaign around Negros to try and reduce the use of cotton buds, because they remove too much of the cerumen, which changes the pH levels in the ear canal, and they can potentially scratch the skin inside, making it susceptible to infection - just as you articulated! The Pinoys just LOVED cleaning their ears several times a day with anything they could find - if there were no cotton buds they would use bobby pins, knitting needles, chicken feathers, pens, matchsticks... whatever!! It's a hard habit to break.

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