Fungal infections of the external ear (Otomycosis- also known as Singapore Ear) are common clinical problem encountered in the ENT practice, especially in hot and humid climatic conditions.
The common fungus encountered are Aspergillus-niger and fumigatus and also Candida albicans. 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 , plus antihistamines for allergy and itching.
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.
