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What Is Otomycosis?

Reviewed by Dan Brennan, MD on April 20, 2021

Otomycosis is an ear infection caused by a fungus. It’s more commonly seen in tropical and subtropical parts of the world, and during times of intense heat and humidity. It’s also known as fungal otitis externa.

Otomycosis usually affects the outer ear canal. This canal starts from your eardrum and continues to the outside of your head. In some cases, it may affect the middle ear as well. About 10% of outer ear canal infections (otitis externa) are caused by fungi.

Causes of Otomycosis

Fungi. There are many different types of fungi that cause otomycosis. The most common fungi that cause these fungal infections are Aspergillus and Candida

Aspergillus is a common fungus that can be found everywhere, both indoor and outdoor. We breathe in Aspergillus spores every day without any problems. But for some people, it can cause health issues like lung infections and allergic reactions. 

There are many kinds of fungus that live in our bodies. Candida is a type of yeast that normally lives on your skin and inside your body, including in your mouth, throat, and gut. Some species can cause infection of candidiasis, of which there are several types, such as oral thrush.

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Antibiotic and steroid use. There has been an increase in otomycosis cases in recent years. Experts say that this increase is due to the widespread use of broad-spectrum antibiotics and steroids, as well as antibiotic ear drops. 

In a study of young people with otomycosis, researchers found that all 26 had used antibiotic ear drops which contained ofloxacin to treat ear discharge.

Some researchers believe that antibiotics affect the pH levels of the ear canal and remove any competing bacteria, making it easier for the fungus to grow.

Weakened immune systems. Otomycosis is seen more often in people who have weakened immune systems. They may have more complications and recurrences of otomycosis. One severe complication happens if the infection spreads to the temporal bone of your skull. If not treated, this can be fatal.

Some risk factors that may make you more likely to get ear canal infections are:

  • Getting water in your ear when swimming 
  • Using cotton swabs to clean your ears and injuring your ear canal
  • Using hearing aids or earplugs, especially if you don’t clean them properly
  • Introducing irritants like hair dye or hair spray get in your ear 

Some people are more prone to ear canal infections. People with skin conditions like eczema, seborrheic dermatitis, or psoriasis, or those with allergies, are more likely to have infections.

Symptoms of Otomycosis

The symptoms of otomycosis include:

  • Hearing loss
  • Itchiness
  • Earache
  • Discharge of fluid
  • Ringing in the ears ( tinnitus)
  • Burning feeling in the ear
  • A feeling of fullness in the ear
  • Severe headaches 

If your ear infection is caused by Aspergillus, grayish-black or yellow dots surrounded by cotton-like fungal spores will form in your ear canal. If it's caused by Candida, there won’t be any visible fungi that forms. Instead, there will be a thick creamy white discharge.

Diagnosis of Otomycosis

Your doctor will talk to you about your symptoms and medical history. They’re likely to use an otoscope to look into your ear canal. Sometimes fungal spores may be seen. They may take a sample of any pus and debris in your ear canal. This sample will be sent to a lab to identify the microorganisms.

Treatment of Otomycosis

Cleaning the ear. Your doctor will first remove any debris from your ear canal. This could involve dry wipes, rinses, or suction. Don’t do this at home with cotton swabs or other objects. 

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Medication. Your doctor will probably prescribe antifungal ear drops. They may contain clotrimazole, fluconazole, or miconazole. In a study of 214 people with otomycosis, researchers found that clotrimazole drops, miconazole cream, and fluconazole drops had the same effectiveness.

If your ear infection is caused in part by a bacterial infection, you may also be prescribed antibacterial drugs like ceftazidime.

It may take 1 to 2 weeks before your otomycosis improves. In some people, otomycosis may be chronic or recurrent. In one reported case, otomycosis that lasted 3 months was due to a different fungus, Malassezia. It lives on the skin of humans and animals, and doctors believe that the source of the infection may have been the person's dog.

Prevention of Otomycosis

There are some things you can try at home to help prevent otomycosis:

  • Wear a swim cap or earplugs when swimming. After swimming, dry your ears with a towel. 
  • Use a hair dryer on a low setting to remove moisture from your ears. Don’t put the hair dryer too close to your ears.
  • Don’t use cotton swabs or other objects to clean your ear. This can push earwax and debris further into your ear canal.
  • Combine equal parts of rubbing alcohol and white vinegar together. Put a few drops in your ear immediately after swimming. Don’t use this option if your eardrum has been perforated, or torn. Talk to your doctor first.  
WebMD Medical Reference

Sources

SOURCES:

BioMed Research International: “Role of Clotrimazole in Prevention of Recurrent Otomycosis.”

Centers for Disease Control and Prevention: “Aspergillosis,” “Candidiasis.”

Ear, Nose, & Throat Journal: “Otomycosis: A clinicomycologic study.”

Indian Journal of Otolaryngology and Head and Neck Surgery: “Type of Antifungals: Does it Matter in Empirical Treatment of Otomycosis?.”

International Journal of Pediatric Otorhinolaryngology: “Topical antibiotic induced otomycosis.”

Journal of Global Infectious Diseases: “Chronic Otomycosis Due to MalasseziaSpp.”

Journal of the Royal Medical Services: “Treatment of Otomycosis: A Comparative Study Using Miconazole Cream with Clotrimazole Otic Drops.”

Mediterranean Journal of Hematology and Infectious Diseases: “Fungal Infections of the Ear in Immunocompromised Host: a Review.”

Merck Manual: “Ear Canal Infection (Swimmer’s Ear).”

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