Ear

Fungal Otitis Externa

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Fungal Otitis Externa, Otomycosis, Jungle Ear

  • See Also
  1. Chronic Otitis Externa
  2. Otitis Externa
  3. Bacterial Otitis Externa
  4. Malignant Otitis Externa
  • Epidemiology
  1. Accounts for 10% of Acute Otitis Externa cases
  2. More common cause of Chronic Otitis Externa cases
  • Etiology
  1. Aspergillus niger (80 to 90% of cases)
    1. Black exudate
  2. Candida albicans (second most common cause)
    1. Cheesy white exudate
  3. Actinomyces
  4. Trichophyton
  • Risk Factors
  1. Extremely moist, hot environments
  2. Chronic Bacterial Otitis Externa
  • Symptoms
  1. Significant Ear canal pruritus more than pain
  2. Sensation of ear fullness
  3. Protracted course of Otitis Externa
  • Signs
  1. Whitish-grey, yellow or black canal exudate
  2. Looks like a Fungal Cave
  3. EntOtomycosis.jpg
  • Differential Diagnosis
  1. Otitis Externa
  • Labs
  1. Potassium Hydroxide (10% KOH)
    1. Fungal hyphae on slide
  • Management
  1. See Otitis Externa for General measures (Ear toilet)
    1. Cleaning and debriding ear is paramount
  2. Otitis Externa Topical Medications
    1. Ear Canal Acidification
      1. Otic Acetic Acid 2% qid for 5 to 7 days
      2. Alcohol and White Vinegar 1:1 mix as drops in ear
    2. Topical Antifungals
      1. Indicated if acidification not effective
      2. Preparations: Intact Tympanic Membrane
        1. Clotrimazole 1% (Lotrimin) drops 3-4 times daily for 10-14 days or until resolved
        2. M-cresyl acetate (Cresylate)
      3. Preparation: Tympanic Membrane Perforation
        1. Tolnaftate 1% Solution (Tinactin)
    3. Systemic Antifungal
      1. Indicated for refractory Aspergillus infection
      2. Preparation: Itraconazole (Sporanox)
  3. Oral Analgesics for 48 hours
  • Prevention
  • Keep ears dry
  1. Instill Alcohol in both ears and let drain qhs
  2. Apply moisturizing cream to edge of ear canal in AM
  • References
  1. Bojrab (1996) Otolaryngol Clin North Am 29:761-82 [PubMed]
  2. Halpern (1999) J Am Board Fam Pract 12(1):1-7 [PubMed]
  3. Lucente (1993) Otolaryngol Clin North Am 26:995-1006 [PubMed]
  4. Mirza (1996) Postgrad Med 99:153-8 [PubMed]
  5. Sander (2001) Am Fam Physician 63:927-42 [PubMed]