II. Epidemiology

  1. Accounts for 10% of Acute Otitis Externa cases
  2. More common cause of Chronic Otitis Externa cases

III. 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

IV. Risk Factors

  1. Extremely moist, hot environments
  2. Chronic Bacterial Otitis Externa

V. Symptoms

  1. Significant Ear canal pruritus more than pain
  2. Sensation of ear fullness
  3. Protracted course of Otitis Externa

VI. Signs

  1. Whitish-grey, yellow or black canal exudate
  2. Looks like a Fungal Cave
  3. EntOtomycosis.jpg

VII. Differential Diagnosis

VIII. Labs

  1. Potassium Hydroxide (10% KOH)
    1. Fungal hyphae on slide

IX. 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

X. 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

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