a common condition encountered and its prevalence is about 10% among patients who presented with signs and symptoms of otitis externa (1,2,3)
pathologic entity, with candida and aspergillus the most common fungal species
not clear that the fungi are the true infective agents or mere colonization species as a result of compromised local host immunity secondary to bacterial infection
various predisposing factors include a humid climate, presence of cerumen, instrumentation of the ear, increased use of topical antibiotics / steroid preparations, immunocompromised host, patients who have undergone open cavity mastoidectomy and those who wear hearing aids with occlusive ear mold
infection is usually unilateral and characterized by inflammatory pruritis, scaling and otalgia (4)
investigation
swabs from infected ears should be examined for both bacteriology and mycology
difficult to cultivate fungi such as Malassezia species can be revealed by use of 10% KOH (Potassium Hydroxide) mount and inoculated on to SDA (Sabouraud's Dextrose Agar) for culture
treatment recommendations have included local debridement, antifungal agents (topical or systemic depending on severity and other factors) and discontinuation of topical antibiotics (3)
sometimes otomycosis presents as a challenging disease for its long term treatment and follow up, yet its recurrence rate remains high
if a otomycosis is suspected then
prescribe a topical antifungal preparation. For mild-to-moderate and uncomplicated fungal infections, consider one of the following options (4):
Clotrimazole 1% solution.
Acetic acid 2% spray (unlicensed use).
Clioquinol and a corticosteroid (for example Locorten-Vioform®)
if there is inadequate response then seek specialist advice (4)
Reference:
Kaur R, Mittal N, Kakkar M, Aggarwal AK, Mathur MD. Otomycosis; a clinicomycologic study. Ear Nose Throat J. 2000;79(8):606-960.
VennevaldI , Schonlebe J, Klemm E. Mycological and histological investigations in Humans with middle ear infections. Mycoses. 2003;46(1-2):12-18.
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