Otomycosis

Otomycosis is a fungal infection of
the ear canal that often occurs due to Aspergillus niger,
A. fumigatus or Candida albicans.It is seen in hot and humid
climate of tropical and subtropical countries. Secondary
fungal growth is also Seen in patients using topical antibjotics
for treatment of otitis externa or middle ear suppuration.
The clinical features of otomycosis include: intense
itching, discomfort or pain in the ear, watery discharge
with a musty odour, and ear blockage. The fungal mass
may appear white, brown or black and has been likened
to a wet piece of filter paper.
Examined with an otoscope, A. niger appears as blackheaded
filamentous growth, A. fumigatus, pale blue or
green; and Candida as white or creamy deposit. Meatal
skin appears sodden, red and oedematous.
Treatment consists of thorough ear toilet to remove all
discharge and epithelial debris which are conducive to the
growth of fungus. It can be done by syringing, suction or
mopping. S pec ific antifungal agent, can be applied.
Nystatin (100,000 units/ml of propylene glycol) is ffective
aga inst Candida. Other broad spectrum antifungal
agenrs include clotrimazo le and povidone iodine. 2% sa licylic
acid in alcohol is also effec tive. It is a keratolytic
agent which removes superficial layers of epidermis, dnd
along with that, the fungal mycelia growing into them.
Antifungal treatment should be continued for a week
even after apparent cure to avoid recurrences. Ear must
be kept dry. Bacterial infections are often associated with
otomycosis, and treatment with an antibiotic/steroid preparation
helps to reduce inflammation and oedema and thus
permitting better penetration of antifungal agents.