Management

Patients with noninvasive fungal otitis externa should be treated with intense debridement and cleansing, and topical antifungals (1)

• topical antifungals, such as clotrimazole and miconazole, are potentially safe choices for the treatment of otomycosis, especially in patients with a perforated eardrum.

UK guidance suggests (2) that if fungal infection is suspected (signs of fungal growth in ear canal): Prescribe a topical antifungal preparation

• .for mild-to-moderate and uncomplicated fungal infections, consider one of the following options:
  • topical antifungal: clotrimazole 1% solution
  • acetic acid 2% spray (unlicensed use)
  • topical preparation containing clioquinol and a corticosteroid for example Locorten-Vioform®
• seek specialist advice if there is inadequate response.

The oral triazole drugs e.g. itraconazole, are effective against Candida and Aspergillus, with good penetration of bone and the central nervous system. These drugs are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis (1).

Reference:

• Vennewald I, Klemm E; Otomycosis: Diagnosis and treatment. Clin Dermatol. 2010 Mar 4;28(2):202-11.
• NICE CKS (April 2021). Otitis externa