Otomycosis

Background

• Also known as fungal otitis externa or "Singapore Ear"
• A superficial fungal infection of the outer ear canal
• Found in 9% of otitis externa cases, and as many as 30.4% of cases of symptoms of otitis
• More common in tropical/subtropical countries.
• Common causes: Aspergillus niger and Candida albicans
• Risk factors:
  • Recent use of topical otic antibiotics
  • Topical or systemic steroids
  • Hearing aid use
  • Pregnancy
  • Local trauma

Clinical Features

• Similar to otitis externa, but with more itching than pain
• Characteristic appearance on exam - appears like "mold growing on spoiled food"
• Otalgia
• Otorrhea
• Hearing loss
• Pruritus
• Tinnitus

Differential Diagnosis

Ear Diagnoses

External

• Auricular hematoma
• Auricular perichondritis
• Cholesteatoma
• Contact dermatitis
• Ear foreign body
• Herpes zoster oticus (Ramsay Hunt syndrome)
• Malignant otitis externa
• Otitis externa
• Otomycosis
• Tympanic membrane rupture
  • Otic barotrauma

Internal

• Acute otitis media
  • Bullous myringitis
• Chronic otitis media
• Mastoiditis

Inner/vestibular

• Labyrinthitis, vestibular neuritis
• Meniere's disease
• Sudden sensorineural hearing loss

Evaluation

• Clinical diagnosis, based on history and physical examination

Management

1. Aural hygiene
2. Topical antifungal
   • Clotrimazole - most effective agent (also has some antibacterial effect)
   • Ketoconazole
   • Fluconazole
   • Nystatin
3. Add PO antifungal treatment if poor response to topical treatment or severe disease

Disposition

• Discharge

See Also

• Fungal infections
• Ear diagnoses