From the Guidelines
Fungal infections of the outer ear (otomycosis) in pediatric patients are typically treated with topical antifungal preparations, with clotrimazole 1% solution being the recommended first-line treatment, applied 3-4 drops to the affected ear three times daily for 7-10 days 1. The treatment of otomycosis in pediatric patients involves the use of topical antifungal agents, which are effective against the most common causative organisms, Aspergillus and Candida species.
- The recommended first-line treatment is clotrimazole 1% solution, applied 3-4 drops to the affected ear three times daily for 7-10 days.
- Alternatively, miconazole 2% solution or nystatin suspension can be used with a similar dosing schedule.
- Before application, gentle cleaning of the ear canal with a cotton swab or irrigation with diluted vinegar solution (1:1 with water) helps remove debris and fungal elements.
- For severe cases or those with significant inflammation, a combination antifungal-steroid preparation like clotrimazole-betamethasone may be used for 5-7 days to reduce inflammation.
- Treatment success requires keeping the ear dry during therapy, so swimming should be avoided and a shower cap or cotton ball with petroleum jelly should be used when bathing.
- Fungal infections typically occur in warm, moist environments and are often seen after swimming or in humid climates.
- They commonly present with itching, pain, discharge, and sometimes a feeling of fullness in the ear.
- Aspergillus and Candida species are the most common causative organisms.
- Recurrence can be prevented by thoroughly drying ears after swimming or bathing and avoiding insertion of foreign objects into the ear canal 1. It is essential to note that the provided guidelines do not specifically address the treatment of otomycosis in pediatric patients younger than 2 years, as the evidence is limited in this age group 1.
From the Research
Fungal Infection of the Outer Ear in Pediatrics
- Fungal otitis externa is a common condition in children, with an incidence of 13.0% as reported in a study from 2015 to 2017 2.
- The primary causative agents of fungal inflammation are fungi of the genera Aspergillus, Candida, and Geotrichum 2.
- Diagnosis of otitis externa relies on the patient's history, otoscopic examination under microscopic control, and imaging studies, as well as direct preparation of specimens and mycologic culture 3.
- Treatment of noninvasive fungal otitis externa typically involves intense débridement and cleansing, and topical antifungals such as clotrimazole, miconazole, and bifonazole 3.
Causative Agents and Treatment
- Aspergillus and Candida spp are the most frequently isolated fungi in patients with otomycosis 3, 4, 5.
- Oral triazole drugs, such as itraconazole and voriconazole, are effective against Candida and Aspergillus, and are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis 3.
- Topical antifungals from the Azole class seem to be the most effective, followed by Nystatin and Tolnaftate 5.
Epidemiology and Risk Factors
- There has been an increase in the prevalence of otomycosis in recent years, linked to the extensive use of antibiotic eardrops 4, 5.
- Fungal infections of the ear are often discovered after multiple oral and ototopical antibacterial medications, and require timely diagnosis with culture for bacteria and fungus 4.
- The use of fluoroquinolone ototopical drops has been associated with an increase in the incidence of positive fungal culture 4.