From the Guidelines
The best treatment for fungal otitis externa is topical antifungal therapy, with clotrimazole 1% solution being the first-line treatment, as it is effective against Aspergillus and Candida species, the most common causes of this infection. Apply 3-4 drops into the affected ear canal three times daily for 7-14 days. Alternatively, miconazole 2% solution can be used with the same dosing schedule 1. Before application, the ear canal should be thoroughly cleaned of debris and discharge, either by gentle irrigation with warm water or careful suctioning by a healthcare provider. This cleaning is essential for the medication to reach the infected tissue. For severe cases or those with significant canal edema, a wick may be placed to facilitate medication delivery.
Key Considerations
- Fungal otitis externa is typically caused by Aspergillus or Candida species and often occurs after prolonged use of antibiotic ear drops, in immunocompromised patients, or in those with diabetes 1.
- Treatment success depends on both eliminating the fungus and addressing predisposing factors like moisture in the ear canal, so patients should keep ears dry during treatment.
- Oral antifungals like fluconazole are rarely needed and reserved for cases with extension beyond the ear canal 1.
Management
- Debridement plus topical antifungal therapy may be necessary for some cases 1.
- Systemic antifungal therapy may be required in immunocompromised patients or in cases of severe infection 1.
- Topical antibiotic therapy is contraindicated in managing otomycosis because it is ineffective and may promote further fungal overgrowth 1.
From the Research
Treatment Options for Fungal Otitis Externa
- The treatment of fungal otitis externa relies on the severity of the infection and the patient's overall health 2.
- For noninvasive fungal otitis externa, intense débridement and cleansing, and topical antifungals such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate are recommended 2.
- Oral triazole drugs, including itraconazole, voriconazole, and posaconazole, are effective against Candida and Aspergillus and are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis 2.
- Clotrimazole 1% solution has been shown to be more effective than Econazole Nitrate 1% + Triamcinolone Acetonide 0.1% cream in the treatment of uncomplicated otomycosis, with a resolution rate of 88.23% compared to 80.39% 3.
Prevention and Management
- Prevention of otitis externa involves avoiding excessive moisture and trauma to the ear canal, as well as avoiding manipulation of the external auditory canal 4, 5.
- Thorough cleansing of the canal is essential for diagnosis and treatment, but flushing should be avoided 4.
- Acidification with a topical solution of 2 percent acetic acid combined with hydrocortisone for inflammation is effective treatment in most cases and, when used after exposure to moisture, is an excellent prophylactic 4.
- Drying the ears with a hair dryer and avoiding manipulation of the external auditory canal may help prevent recurrence 4.