From the Guidelines
Treatment for fungal acute otitis externa typically involves antifungal medications, such as topical antifungals or boric acid, and thorough mechanical cleansing of the external auditory canal.
Key Treatment Options
- Topical antifungals: clotrimazole, miconazole, or nystatin, which can be used as ear drops or ointments 1
- Boric acid: can be used as an alternative to topical antifungals 1
- Systemic antifungals: such as voriconazole, may be necessary for more severe or widespread infections, especially in immunocompromised patients 1
Treatment Approach
- Mechanical cleansing: thorough cleaning of the external auditory canal to remove debris and promote healing 1
- Combination therapy: using a combination of topical antifungals and mechanical cleansing may be more effective than using a single treatment approach 1 It's worth noting that the treatment approach may vary depending on the severity of the infection and the patient's underlying health status, with more severe cases requiring systemic antifungal therapy and surgical intervention 1.
From the Research
Treatment for Fungal Acute Otitis Externa
The treatment for fungal acute otitis externa involves a combination of intense débridement and cleansing, and topical antifungals 2. Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate, are potentially safe choices for the treatment of otomycosis, especially in patients with a perforated eardrum 2.
Topical Antifungal Therapy
- Clotrimazole is a commonly used topical antifungal agent for the treatment of fungal otitis externa 2, 3.
- A combined drug containing chloramphenicol, clotrimazole, beclomethasone, and lidocaine (Candibiotic) has been shown to be effective in treating acute otitis externa, with a clinical efficacy of 69.7% and complete eradication of microorganisms in 87% of cases 3.
Systemic Antifungal Therapy
- Oral triazole drugs, such as itraconazole, voriconazole, and posaconazole, are effective against Candida and Aspergillus, and have good penetration of bone and the central nervous system 2.
- Intravenous amphotericin B and oral itraconazole have been used to treat fungal necrotizing otitis externa, with a high success rate 4.
Diagnostic Considerations
- The diagnosis of otitis externa relies on the patient's history, otoscopic examination under microscopic control, and imaging studies 2.
- Direct preparation of specimens, particularly with optical brighteners, mycologic culture, and histologic examination, is very important and strongly recommended for the correct diagnosis 2.