title: Otitis externa in military divers: more frequent and less harmful than reported.
abstract: Although otitis externa (OE) is a common disease, data related to (military) divers are limited. This study aimed to determine the incidence of OE in military divers during their initial training. We also wished to consider seasonal influences on incidence and whether early detection increases completion of the diving course.
  
  
  
  From January 2011 to October 2016 the Royal Netherlands Navy Diving School trained 189 divers. Up to December 2015 we used the training records for the analyses. From January 2016 onward all divers were prospectively screened. Pearson's chi-squared 2 and Fisher's exact tests were used to analyse the data.
  
  
  
  In the 162 included divers, 30 cases of OE were identified. The incidence in 2016 was significantly higher than in 2011-2015 (17/35 (49%) versus 13/127 (10%), P < 0.001). Almost all cases developed after three weeks of diving. No influence of season was found (P = 0.354). Early diagnosis and treatment of OE does not seem to affect completion of diving courses (P = 0.28). Only in three cases did a diver have to discontinue the course due to OE.
  
  
  
  This study suggests that OE is more frequent among military divers than earlier reported, most likely caused by prolonged water exposure. Diving activities can often be continued with standard topical treatment.
authors.affiliation: Royal Netherlands Navy Diving Medical Center, Rijkszee en marinehaven, 1780 CA Den Helder, The Netherlands tt.wingelaar@mindef.nl.|Department of Anesthesiology, Academic Medical Center, University of Amsterdam.
authors.forename: Thijs T
authors.initials: TT
authors.lastname: Wingelaar
authors.affiliation: Diving Medical Center, Royal Netherlands Navy.
authors.forename: Pieter-Jan Am
authors.initials: PA
authors.lastname: van Ooij
authors.affiliation: Department of Anesthesiology, Academic Medical Center, University of Amsterdam.
authors.forename: Rob A
authors.initials: RA
authors.lastname: van Hulst
mesh_terms: D016009:Chi-Square Distribution; D004242:Diving / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D010032:Otitis Externa / Q000453:epidemiology* / Q000209:etiology; D012621:Seasons; D018709:Statistics, Nonparametric
keywords: Ear infection; Scuba diving; Treatment