From the Guidelines
Treatment for Fungal Otitis Externa
Fungal otitis externa should be treated with topical antifungal agents, such as clotrimazole 1% solution or cream, applied 2-3 times daily for 2-4 weeks 1.
- Alternatively, oral antifungal agents like fluconazole 150-200mg daily for 1-2 weeks may be considered in severe cases 1.
- Additionally, cleaning and debridement of the ear canal, as well as avoidance of moisture and use of ear drops containing acetic acid 2% or aluminum acetate 5% to help maintain a dry ear canal environment, are also recommended 1.
- In some cases, combination therapy with topical antibiotics, such as neomycin or polymyxin B, may be necessary to treat concurrent bacterial infections 1.
- It is essential to note that topical antibiotic therapy is contraindicated in managing otomycosis because it is ineffective and may promote further fungal overgrowth 1.
- The choice of treatment may depend on the severity of the infection, the patient's immune status, and the presence of any underlying conditions, such as diabetes or HIV infection 1.
From the FDA Drug Label
For the treatment of superficial infections of the external auditory canal caused by organisms susceptible to the action of the antimicrobial. Carefully remove all cerumen and debris to allow acetic acid otic solution to contact infected surfaces directly. To promote continuous contact, insert a wick of cotton saturated with acetic acid otic solution into the ear canal; the wick may also be saturated after insertion. Instruct the patient to keep the wick in for at least 24 hours and to keep it moist by adding 3 drops to 5 drops of acetic acid otic solution every 4 hours to 6 hours. The wick may be removed after 24 hours but the patient should continue to instill 5 drops of acetic acid otic solution 3 times or 4 times daily thereafter, for as long as indicated.
The treatment for fungal otitis externa (infection of the outer ear canal) is acetic acid otic solution. The solution should be administered by:
- Removing all cerumen and debris from the ear canal
- Inserting a wick of cotton saturated with the solution into the ear canal
- Keeping the wick in for at least 24 hours and moistening it with 3-5 drops of solution every 4-6 hours
- Instilling 5 drops of solution 3-4 times daily after the wick is removed, for as long as indicated 2, 3.
From the Research
Treatment for Fungal Otitis Externa
- The treatment for fungal otitis externa relies on the patient's history, otoscopic examination, and imaging studies 4.
- Patients with noninvasive fungal otitis externa should be treated with intense débridement and cleansing, and topical antifungals 4.
- 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 4.
- The oral triazole drugs, itraconazole, voriconazole, and posaconazole are effective against Candida and Aspergillus, with good penetration of bone and the central nervous system, and are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis 4.
Comparison of Treatments
- There is limited information available on the treatment of fungal otitis externa, and most studies focus on the treatment of bacterial otitis externa 5, 6, 7, 8.
- However, it is worth noting that some studies have compared the efficacy of different treatments for otitis externa, including topical antimicrobials, steroids, and ear cleaning 7.
- The results of these studies suggest that topical treatments alone are effective for uncomplicated acute otitis externa, and the choice of topical intervention does not appear to influence the therapeutic outcome significantly 7.
Key Points
- Fungal otitis externa requires a different treatment approach than bacterial otitis externa 4.
- Topical antifungals and oral triazole drugs are effective treatments for fungal otitis externa 4.
- The treatment of otitis externa should be based on the patient's history, otoscopic examination, and imaging studies 4.