Fungus in the Ear – Otomycosis

Fungal infections of the external ear (Otomycosis) are common clinical problem encountered in the ENT practice, especially in hot and humid climatic conditions. From the Department of ENT, Bahrain Defence Force Hospital, we conducted a prospective study in 193 patients having fungal infections in the ear.

(Ref- Mycotic Infection of the Ear (Otomycosis). The Journal of Laryngology and Otology (JLO -Journal of Laryngology and Otology-London UK)-By K. O. Paulose, S. Al-Khalifa, P K Shenoy and R K Sharma January 1989, Vol. 103, pp. 30-76)

Out of 193 patients, in 171 cases we isolated Aspergillus Niger, Fumigatus and Candida species pathogens. This was a prize winning study conducted by the Bahrain medical society)

There will be always superadded bacterial infection along with fungus.

Symptoms

Itching- intolerable urge to clean the ear, often cause further trauma to the ear canal
Pain, discomfort, feeling the ear blocked, and mild discharge are also noted. Some patients will have co existent CSOM with a mucoid discharge. Tinnitus (ringing in the ear) and vertigo also can occur.

Signs

Absence of healthy wax is noticed in most of the ears. External auditory canal shows edema, and black discharge, at time like wet tissue paper in the ear.

Why fungus in the ear?

The ear canal can be easily infected because it is dark and warm, hence bacteria or fungus may grow there, because of high humidity and moisture. This occurs more in those who wear head cover in some part of the world.
Otomycosis most often occurs when too much water gets in the ear canal such as after swimming or showering in chlorinated water. It is also called Swimmers ear or Singapore ear. It is easier for germs and fungus to grow when water removes the protective ear wax. Too much cleaning your ears can have the same effect.

Treatment

Send a swab for microbiological tests to identify the fungal and bacterial pathogens
1. Clean the ear canal by vacuum suction under an operating microscope using normal saline at body temperature. If the ear is painful instill little local anesthetic drops before cleaning. Remove all the fungal debris and discharge.
2. Insert a medicated wick with antifungal and antibiotic cream/ointment.
3. Analgesics if there is pain
4. A broad spectrum antibiotic for 5 days
5. Avoid swimming, or water getting into the ear until the fungal infection is fully eradicated.
6. Systemic antifungal therapy like ketaconazole, Iconazole rarely. Make sure the patients are not diabetic, liver and kidney functions are normal.
7. Visit the doctor and make sure the fungus is eradicated from the ear.

Antifungal agents commonly used

Clotrimazole, Gentian violet,Tolnaftate,Nystatin,Acetic acid, and Econazole

How to prevent Fungus in the ear

To prevent Otomycosis, it’s important to keep the ear canal’s natural defenses against infection working well. Leave some amount of ear wax in the canal, this has an antifungal property.
After swimming or showering, use a towel to dry your ears well. Turn your head to each side and pull the earlobe in different directions to help water run out. A hair dryer set on the lowest speed and heat can also help dry ears, but be sure to hold it several inches from your ear. After swimming in common pool, put few drops of acetic acid ear drops or any other antifungal ear drops.
Use ear plugs, when swimming. Custom made ear plugs can be available from a hearing aid shop.