Otomycosis is a fungal infection that affects the external portion of the ear. A variety of fungal species can cause this infection, resulting in symptoms such as pain, redness, and decreased hearing. The diagnosis of the condition typically relies on observing the clinical symptoms and studying the discharge produced as a result of the infection. Treatment of the infection is usually accomplished with topical or oral antifungal medications.
A number of different fungal species can cause otomycosis. The most common etiologic agent is Aspergillus, which accounts for over 80% of cases. Candida, a different type of fungus, is the second most common cause. Rarer causes can include Rhizopus, Actinomyces, and Phycomycetes. Many of these fungal species are prevalent in the environment and only cause an infection of the external ear in at-risk patients, such as those who have decreased immune systems or who have diabetes mellitus.
Symptoms of otomycosis can include pain, redness of the external ear canal, and itchiness. The condition is often associated with a discharge from the ear that can be thick and yellow in nature. Other times this discharge can be white or black. Many patients report having a sense of the ear being full, and can have problems hearing on the affected side.
The diagnosis of otomycosis relies on understanding the clinical symptoms of the patient as well as knowing what other diseases the affected patient has. Patients with diabetes mellitus or suppressed immune systems are at an increased risk for developing this condition as compared to the general population. Regardless, patients are often misdiagnosed and given antibiotic ear drops because their physicians assume that the external ear infection is caused by bacteria instead of fungi. When patients do not improve with antibiotics, fungi might then be considered as a cause of infection. The diagnosis can be confirmed by taking a sample of the discharge from the ear and examining it under the microscope for the presence of fungi.
Treatment of otomycosis relies on prescribing antifungal agents. The ear is often initially cleaned after the diagnosis is made in hopes of removing as much of the fungus as possible. Patients are then typically given antifungal ear drops containing active ingredients such as clotrimazole or ketoconazole. Some physicians alternatively provide ear drops containing the active ingredients thimerosal or gentian violet. More severe otomycosis infections might require oral antifungal agents.
Although otomycosis is typically easily treated, some patients, particularly elderly patients with diabetes mellitus, are at risk for the infection spreading past the ear and into the base of the skull. Further invasion can be deadly, particularly if the bones of the skull are affected. The treatment of this condition requires hospitalization and treatment with intravenous medications.