Otomycosis is fungal infection of the external auditory canal. Many external infections of the outer ear are fungal in origin. The most characteristic finding on ear examination is the presence of greyish white thick debris like a wet blotting paper. Most fungal ear infections are caused by Candida albicans and Aspergillus niger although exceptions exist.

Clinical Presentation

The typical presentation is itching, inflammation, pruritus, scaling, and severe uneasiness. The mycosis results in superficial epithelial exfoliation and masses of debris containing suppuration and hyphae. Pruritus is more marked than with other forms of ear infections and discharge is often a marked feature.

The initial presentation is similar to bacterial otitis externa but otomycosis is characterised by, white, many long, filamentous hyphae growing from the skin surface. Sometimes the diagnosis of fungal infection may be thought of only when the condition fails to respond to antibiotics. There may be more than one aetiological agent, even if bacteria have been grown.

An essential piece of history that may easily be missed is a holiday in an exotic place with surfing or SCUBA diving.

Investigations

Swabs from infected ears should be examined for both bacteriology and mycology.

Management

Otomycosis is a chronic recurring mycosis. Ear canal should be cleared of debris and discharge Suction can be used if available preferably under the microscope. Cleaning may be required several times and pain killers may also be essential.If there is an irritant or allergen it must be removed. Maintain the ear dry and avoid scratching it with cotton wool buds. Keep away from cotton wool plugs in the ear unless discharge is very profuse.

Antifungal ear drops are of worth, there is no consensus on treatment. But evidence supports the use of topical ketoconazole. Econazole and Clotrimazole drops are very effective and may be needed for 1 to 3 weeks. In the presence of a perforated eardrum, cleaning of the ear can be a problem and utmost care has to be taken while suction cleaning is done under the microscope.

Prognosis

Once antifungal therapy is started, there is usually good resolution .Take care to avoid excessive moisture by avoiding water entry to the ear and receiving appropriate medical or surgical treatment for otitis externa. Dandruff if present has to be treated as it can be the cause of the fungus.