Otomycosis is a fungal infection of the external auditory canal.

Etiology

The most common pathogens are Aspergillus, Penicillium, and Candida species. Fungal infections are more likely to occur when water enters the external auditory canal, secretions accumulate, or antibiotics are used as ear drops for prolonged periods.

Clinical manifestations

Mild cases may be asymptomatic and are only detected during examination.

Common symptoms include pruritus and ear fullness, with occasional intense pruritus, particularly at night.

It is often secondary to chronic suppurative otitis media. When bacterial infections are also present, symptoms may include swelling and pain in the external auditory canal, along with purulent discharge.

Extensive fungal growth can form clumps that block the external auditory canal.

On examination, the external auditory canal and tympanic membrane may be covered with yellowish black or white powdery or velvety fungal debris. Thin membranous or tubular crusts may also be observed. After removing the crusts, the affected area may appear mildly congested, moist, or show purulent discharge.

Microscopic examination of crusts removed from the ear, after adding 1 - 2 drops of 10% potassium or sodium hydroxide solution, can reveal fungal hyphae and spores. Fungal culture can also be performed for confirmation.

Figure 1 Otomycosis

Prevention

Individuals should keep the external auditory canal dry. If water enters the ear, dry it promptly with a cotton swab.

For mild pruritus or small amounts of discharge, 4% boric acid ethanol solution can be instilled into the ear.

Antibiotic ear drops and corticosteroids can be used judiciously.

Treatment

1% - 3% salicylic acid ethanol solution or 1% - 2% thymol ethanol solution can be applied to the ear.

Nystatin can be sprayed into the external auditory canal, or broad-spectrum antifungal agents, such as imidazoles, can be applied.

Antifungal medications can be chosen based on fungal culture and sensitivity results.

Individuals should keep the external auditory canal as dry as possible.

Systemic antifungal therapy is generally not required.