Otomycosis

Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal. It is more common in tropical countries. The infection may be either subacute or acute and is characterized by malodorous discharge, inflammation, pruritus, scaling, and severe discomfort. The mycosis results in inflammation, superficial epithelial exfoliation, masses of debris containing hyphae, suppuration, and pain.

Signs and symptoms

Otoscopy (exam of the ear) is best done with a binocular microscope that provides adequate lighting, depth perception, and the ability to instrument the ear to comfortably remove the fungus. Findings range from scattered saprophytic fungal colonies of various colors, causing no symptoms, to densely packed fungal debris, often intermixed with cerumen (wax), filling the entire canal and involving the tympanic membrane (eardrum). The fungus can cling to the skin and tympanic membrane, presumably because of invading hyphae, and can require significant time to accomplish complete removal.

Cause

Most fungal ear infections are caused by Aspergillus niger, Aspergillus fumigatus, Penicillium and Candida albicans. Otomycosis commonly results from overuse of antibacterial ear drops, which should never be used for more than 7 days. In such cases the fungus is an opportunist that results from antibacterial suppression of the normal bacterial flora, combined with the steroid the drops also contain.

Diagnosis

Otomycosis does not usually cause as much canal skin edema as does acute bacterial external otitis. While a severe pressure type of pain is a prominent feature of advanced cases, the ear is usually much less tender, if at all, to traction or tragal pressure. Appearance of the fungus is variable, most commonly gray, white, or black, often intermixed with cerumen and clinging to the canal skin. Gray concretions may be present. It can require significant time to remove, best done with suction and microscopic ear instruments, by an ENT specialist.

Treatment

Complete removal of the fungus resolves the pressure and provides immediate relief of the pain seen in severe cases. The residual fungus is treated with topical antifungals, usually either 1% tolnaftate (Tinactin) or 1% chlortrimazole (Lotrimin) solution, 10 drops twice a day for 3 days. Very occasional species of fungus can be resistant to these common antifungals and require a second tier antifungal. --> Per a study in Iran 10cc acetic acid 2% plus 90 cc of isopropyl alcohol 70% was effective.