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Otomycosis | Aetiology | Pathology | Symptoms | Treatment

Otomycosis is one type of fungus infection. It becomes very common in the rainy season. It is a very painful infection accompanied by itching. It is an otitis externa caused by the fungus. 

 Aetiology :

  • Moisture: Water entering the ear, as a result of swimming or taking a bath, may carry the fungus into the ear. The fungus gets implanted in the skin of the ear canal and grows luxuriously, as humidity is provided by water and heat is provided by the body. 
  • Antibiotics: Prolonged use of antibiotics drops kills the bacteria, thus fungus may start growing unhindered.
  • Causative organisms: Aspergillus niger is one of the commonest fungus causing the infection. Monilial and other fungal infections which affect the skin may also be responsible. 
Pathology :

The fungus tends to invade the deep layers of the skin, and hence the treatment should be given for a long time, till the fungus extending into the deeper layers of the skin has been cleared up. Secondary bacterial infection may follow. 

Symptoms :
  • Itching is often the presenting symptom. 
  • Pain: Gradually the ear becomes extremely painful.
  • Otorrhoea: Brownish or blackish discharge may appear.
  • Deafness is caused by the collection of discharge and debris in the ear. The inflammatory stenosis of the external auditory canal also leads to deafness.
  • Tinnitus may be present.
  • Trismus may be also present. 
Signs :
  • Cotton like growth: The external auditory canal shows the presence of cotton-like growth. Initially, resembling the fungal growth seen on bread in the rainy season. 
  • A wet newspaper like mass: The appearance changes to that of a wet newspaper like mass presenting a multi-coloured appearance, ranging from white to grey, brown or black colour. 
  • Other features of otitis externa are also present. 
Treatment :

Local :
  • Antibiotics drops should be discontinued, of they are being instilled.
Ear drops : 
  • 1 % Clotrimazole and tolnaftate is the wide spectrum antifungal solutions, which are very effective and less irritating.
  • 1 % Salicylic acid in methylated spirit kills the fungus. 
  • 2 % Acetic acid drops may be used, but are not so effective. 
  • 1 % Gentian violet is antifungal and antiseptic but it discolours the ear canal, and this interferes with the clinical examination.  
  • Antifungal antibiotics like hamycin and nystatin are also useful. 
Cleaning the ears :
  • All the debris must be removed repeatedly and the treatment should be given for at least 2 weeks. 
  • Water should be prevented from entering the ear. 
Systemic : 
  • Antibiotics may be given to control secondary bacterial infection.
  • Analgesics : Since the pain is very severe analgesics are prescribed.
  • Antipruritic : Agents may be given.
  • Antifungals may be given to resistant cases. 
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