Hlustarbólga eftir sundnámskeið

Abstract

Objective: This study reports an outbrake of external otitis in boarding school children after they had participated in an intensive swimming course. The infective agent isolated was P. aeruginosa. The question is raised whether the outbrake was caused by water contaminated by bacteria or intensive bathing. Material and methods: Twenty-seven children from a rural boarding school, aged 10 to 14 years participated in an obligatory swimming course for two weeks. As the outbrake became evident all the children were examined by two doctors with an otomicroscope. Bacterial culture was taken from the external acoustic meatus (EAM) on both sides and a tympanogram was performed on all. Subjective evaluation of symptoms was achieved by using a questionnaire. Eight weeks after the swimming course ended all participants were investigated again with an ear microscope and control bacterial culture was taken from the EAM for appreciation of the outcome. Results: Seventeen (63%) of the 27 children had symptoms of external otitis on the first visit. Microscopic investigation of those infected revealed seven (41.2%) children with mild, four (23.5%) with mode¬rate and six (35.3%) with severe inflammation of the EAM. Of those children affected 12 (70.6%) had infection in both ears. P. aeruginosa was isolated from 11(64,7%) of those affected and from two of those who had no symptoms. The mean onset of symptoms was 2.1 days (standard error 0.5) after the swimming course had ended. The mean time for symptom relief was 11.4 days (standard error 2.2). Conclusions: Intensive swimming courses in pools where the quality of the water is checked sporadically is not advised. If intensive swimming courses are necessary the concentration of chlorine should be carefully monitored as well as checked for growth of both Cloriform bacteria and P. aeruginosa.

Tilgangur: Tilgangur rannsóknarinnar var að lýsa faraldri hlustarbólgutilfella sem stafaði af P. aeruginosa í kjölfar sundnámskeiðs í heimavistarskóla. Efniviður og aðferðir: Tuttugu og sjö börn á aldrinum 10-14 ára, nemendur í heimavistarskóla á Austurlandi tóku þátt í sundnámskeiði sem stóð í tvær vikur. Börnin fóru í sund fjórum sinnum á dag (mánudag-föstudag) á tveggja vikna tímabili. Þegar ljóst varð að tilfellum hlustarbólgu fór fjölgandi meðal þeirra voru öll börnin skoðuð af tveimur læknum með eyrnarsmásjá, einnig var gerð hljóðhols- (þrýstings) mæling á miðeyrum. Bakteríuræktanir voru teknar úr hlust báðum megin. Niðurstöður: Alls fengu 17 (63%) af börnunum einkenni hlustarbólgu meðan á sundnámskeiðinu stóð eða strax á eftir. Skoðun með eyrnasmásjá sýndi að sjö þeirra höfðu væg bólgueinkenni, fjögur millistigs en sex höfðu miklar bólgubreytingar í hlustargangi. Tólf (70,6%) þessara bama höfðu bólgubreytingar báðum megin. P. aeruginosa ræktaðist frá 11 (64,7%) þeirra sem höfðu einkenni en tveimur sem höfðu engin einkenni. Einkenni byrjuðu að meðaltali 2,1 degi (staðalskekkja 0,5) eftir að námskeiðinu lauk og stóðu í 11,4 daga (staðalskekkja 2,2). Alyktanir: Ekki er hægt að ráðleggja endurteknar sundlaugarferðir á stuttum tíma nema gæði vatnsins séu tryggð með reglulegu eftirliti og ræktunum á bæði kólíbakteríum og P. aeruginosa.