Otomycosis, or fungal infection of the external ear canal, is common in tropical countries, humid locations, after longterm topical antibiotic therapy, and in those with diabetes, HIV infection, or an immunocompromised state (1)
- Aspergillus species (60%-90%) and Candida species (10%-40%) are often cultured (1)
- often presents with pruritus, scaling, inflammation and discomfort
- itching (usually the most prominent symptom) and signs of scratching are often seen (1,2,3)
- signs of fungal infection on examining the ear canal - whitish cotton-like strands of Candida, small black or white balls of Aspergillus ( ("wet newspaper")
- the consideration of possible fungal infection may arise only when the condition fails to respond to antibiotics
- fungal infection may occur secondary to use of topical antibiotics
- important elements in history include a possible recent holiday in warm and holidaying in warm climate and doing water based sports such as surfing or scuba diving
- fungal otitis externa should also be suspected if a patient fails to respond to initial topical therapy (3)
Reference:
- Rosenfeld RM, Schwartz SR, Cannon CR, et al. Clinical practice guideline: acute otitis externa.Otolaryngol Head Neck Surg2014;150(Suppl):S1-24.doi: 10.1177/0194599813517083
- NICE CKS (April 2021). Otitis externa
- Barry V et al. 10-Minute Consultation - Otitis externa. BMJ2021;372:n714http://dx.doi.org/10.1136/bmj.n714