From the Guidelines
Otomycosis, a fungal infection of the ear, is typically treated with thorough mechanical cleansing of the external auditory canal followed by topical antifungals or boric acid, as recommended by the Infectious Diseases Society of America in 2016 1. Fungal ear infections, also known as otomycosis, occur when fungi like Aspergillus or Candida species grow in the ear canal. These infections typically cause itching, pain, discharge, and sometimes hearing loss. The ear discharge is often thick and may appear white, yellow, or black depending on the fungal species.
Key Characteristics of Otomycosis
- Fungal infections commonly develop in warm, moist environments, making them more prevalent in humid climates or in people who swim frequently.
- Treatment usually involves thorough cleaning of the ear canal by a healthcare provider followed by antifungal medications.
- For noninvasive Aspergillus otitis externa, topical antifungals or boric acid are recommended, as stated in the 2016 update by the Infectious Diseases Society of America 1.
Treatment Options
- Topical therapy with irrigating solutions of boric acid, acetic acid, or azole cream may be effective in eradicating Aspergillus otomycosis, as suggested in the 2008 clinical practice guidelines 1.
- For severe infections, oral antifungals like voriconazole, posaconazole, or itraconazole may be necessary, especially in cases of invasive aspergillosis or compromised immune systems.
Prevention and Management
- To prevent recurrence, it is essential to keep ears dry, avoid inserting objects into the ear canal, and complete the full course of medication even if symptoms improve quickly.
- People with diabetes or compromised immune systems are at higher risk for fungal ear infections and may require more aggressive treatment, as they are more susceptible to severe infections.
From the Research
Definition and Prevalence of Otomycosis
- Otomycosis is a fungal infection of the ear that affects 4 in 1,000 persons annually in its acute form and 3-5% of the population in its chronic form 2.
- The disease is caused by various fungi, primarily saprophytes, including Candida albicans and Aspergillus niger 2, 3, 4.
Symptoms and Treatment of Otomycosis
- Otomycosis can pose a significant challenge in treatment, requiring prolonged treatment and follow-up, and has a significant chance of recurrence 2.
- Treatment options include local debridement, local and systemic antifungal agents, and utilization of topical antiseptics 5.
- Topical therapy includes the use of antifungals, such as clotrimazole or miconazole, often given along with ceftazidime, an antibacterial 2.
- Clotrimazole works by impairing the permeability barrier of the cytoplasmic membrane of the fungi, causing holes to appear in the cell membrane and leading to the death of the fungus 2.
Fungal Pathogens and Antifungal Susceptibility
- The most common fungal pathogens causing otomycosis are Aspergillus and Candida species, with Aspergillus niger being the predominant isolate 3, 6, 4.
- Antifungal susceptibility testing has shown that mold isolates have the highest sensitivity to voriconazole, while yeast isolates have the highest sensitivity to nystatin 3.
- Terbinafine has been identified as a effective antifungal agent against both Aspergillus and Candida species 6.
Risk Factors and Prevention
- Various host and environmental factors can predispose a person to otomycosis, including self-cleaning, instillation of mustard oil, and use of ear drops 4.
- Proper identification of causative agents is mandatory to prevent recurrences and complications 4.
- Avoiding the use of home remedies and eardrops, and practicing good ear hygiene can help prevent otomycosis 4.