Ear

Fungal Otitis Externa

search

Fungal Otitis Externa, Otomycosis, Jungle Ear

  • 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
  • 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
        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