PREVENTION OF OTITIS IN THE SWIMMER

or entering the external ear canal and the middle ear via a perforation in the eardrum membrane. Interest in this study was stimulated primarily by two types of cases : first, that of the patient with a perforation of the eardrum membrane, which the otologist is attempting to close by repeated treatments, who, in the midst of treatment, goes swimming or gets water into the middle ear during a shower bath, with ensuing infection and delay in the treatment; second, that of the patient with external otitis whose complaint was apparently initiated or is aggravated by water entering the ear canal. That water may also enter the middle ear via the Eustachian tube is not to be denied.1 Nielsen 2 stated, in writing on swimmer's otitis, that in 90% of the patients he examined the otitis was caused by pneumococci which, he felt, were endogenous, arising from nasopharyngeal bacteria, and that impure bathing water played no etiologic role. Nielsen called attention to the fact that water forced through the nose into the nasopharynx washes away the protective layer of mucus