What is Otomycosis or Ear Fungus?
Otomycosis or Ear Fungus is also known as Mycotic Otitis Externa, Singapore Ear and Fungal Ear Infection. The published data suggests 7% of patient suffering with infection of external ear had fungal Otomycosis.1
Otomycosis or Ear Fungus is the condition caused by fungal infection of the external ear. External ear is a tubular anatomical bony structure open to atmosphere on one side and the opposite side is covered by ear drum or tympanic membrane. “Otomycosis” is the word formed by two words “oto” means ear and “mycosis” means fungus. The word Otomycosis suggests fungal infection of external ear. Several varieties of funguses cause infection of external ear. Such fungal infection of externa ear is caused by fungi such as Aspergillus or Candida, Actinomyces, Phycomycetes, and Rhizopus.
Otomycosis infection is a rare ear disease. Most of these fungal species exist in the environment around us and can easily come in contact with external ear, but not everyone gets infected. Otomycosis fungal infection of external ear is seen in individual suffering with weak immune system and patients suffering with diabetes mellitus. Weak immune system is observed in patient suffering with HIV viral infection and taking large dosage of steroid as well as chemotherapy.
Otomycosis or Ear fungus causes symptoms like ear pain and fever. Thus, the disease is often misdiagnosed as a bacterial infection instead of fungal infection. Most individuals suffering with Otomycosis are initially treated with antibiotics ear drops and oral pills or capsules for several weeks. Physician suspects fungal infection when antibiotics do not improve the condition.
Causes of Otomycosis or Ear Fungus Infection
- Contaminated swimming pool water
- Crowded swimming pool
- Unclean towels
- Prolonged use of antibiotics
- Immune deficiency
- Cortisone treatment and
- Contaminated Swimming Pool Water- The most common cause of Otomycosis or Ear Fungus is the contaminated swimming pool water. One can also get infected when shower water is contaminated. Such condition is seen in Asia or Africa while travelling and staying in hotel.
- Crowded Swimming Pool- Individual suffering with Otomycosis contaminates the swimming pool water as well as furniture around the pool and towel, that is provided by facilities. The normal healthy individual when shares these objects, the fungal particles or spores are transmitted from source to person. Such transfer of fungus results in Otomycosis infection of external ear. The infection spreads rapidly to several normal individual when pool area is crowded.
- Unclean Towels- The towels are shared in public gym and hotels. If the laundry service is not equipped to clean the contaminated towels, then fungus stays active within the fabrics of towel. Sharing the towel causes transmission of fungus to healthy individuals that results in Otomycosis of external ear.
- Prolonged Use Of Antibiotics For Infection- Prolonged consumption of antibiotics for infection causes hyperactivity of fungi. The fungus growth within normal tissues increases as the individuals white blood cells become lethargic as in case when prolonged antibiotic treatment is recommended.
- Cortisone and Chemotherapy Treatment- Prolonged cortisone therapy or prescription of large dosage of cortisone causes immune deficiency.2 Such condition promotes Otomycosis fungal growth. The normal immunity maintains active white blood cells against bacterial and fungal infection. Lower immunity with weaker white blood cells promote fungal growth and infection.
- HIV and AIDS– AIDs is an autoimmune deficiency syndrome. HIV infection is a viral infection and spread of such infection causes weak immunity by decreasing the normal function of white blood cells. The HIV viral infection is also known as AIDS, when white blood cells become extremely weak against bacterial and fungal infection. Otomycosis is frequently observed in individual who are suffering with immune deficiency.2
- Malnourishment- Malnourishment decreases the mineral and vitamin concentration in human body. Such condition results in weak immunity that causes increased chances of fungus infection like Otomycosis.
Signs and Symptoms of Otomycosis or Ear Fungus
- Earache- Pain in external ear is also known as earache or Otalgia. Earache caused by Otomycosis or fungal infection of external ear is mostly felt in external ear and behind mandible.
- Ear Secretions (Otorrhoea)- The secretion from external ear drains out during most of the day. The secretion in few cases is foul smelling because of presence of pus. The pus is often yellowish in color. External eat often looks red and inflamed. The ear secretion is also known as Otorrhoea.
- Itchiness or Pruritus- Mild to severe itching is localized within external ear and also over the skin covering mandible and jaw.
- Swelling- The swelling is observed over the upper section of neck next to opening of external ear. The swelling is caused by infected enlarged lymph node. The touch and palpation of swelling triggers pain.
- Decreased Hearing- The wax and pus in external ear causes decrease in hearing.1 Hearing loss is also caused by perforation or damage of ear drum. Individual experiencing ear discharge and hearing loss should consult primary care physician or ENT specialist as soon as possible. During weekend or after working hours you must visit ER to investigate the cause of symptoms.
Diagnostic Studies For Otomycosis or Ear Fungus2
- Otoscopy- External ear canal is examined by using otoscope. Otoscope focuses light in external ear through a plastic cone and examiner can see magnified view of external canal. In most cases wax and purulent secretion is observed in external ear. The sample of secretion and wax is collected during examination for microscopic and histopathological lab studies.
- CT scan and MRI Studies of Ear- Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI) images are examined for diseases in middle and external ear. Such radiological studies help to evaluate cancer growth, wax size and collection of pus in middle as well as external ear.
- Microscopic Examination-
- Histological examination- Specimen collected from external ear is stained and examination under microscope to see fungus or bacteria.
- Culture of Secretions- The sample is cultured for fungal colony growth. Such study is also known as mycologic culture. The samples of culture are stained and then examined under microscope to find the cause of symptoms. The differential diagnosis includes microscopic examination of sample of culture growth. The microscopic examination differentiates presence of bacteria and fungus as well as wax and cancer growth.
Treatment for Otomycosis or Ear Fungus
The treatment plan of Otomycosis depends on severity of symptoms. Mild to moderate Otomycosis or ear fungus infection is treated with conservative treatment. The symptoms like discharge of purulent secretion and loss of hearing is considered as urgent situation and immediate specific treatment is considered. If treatment is delayed recurrence rate of Motomycosis or Ear Fungus is high.3
Following Are The Treatment Choices To Treat Otomycosis:
- Dry ear after bath and swimming
- Ear Wash
- Ear wax removal
Antifungal ear drops
Gentian Violet drops
Antifungal ear drops
Conservative Treatment of Otomucosis or Ear Fungus
- Keep External Ear Dry- Ear is kept dry during initial phase of disease when individual does not complaint of ear secretion or loss of hearing. Moist ear helps the fungal growth and fungal growth is less significant if ear is dry.
- Rinse Ear With Normal Saline Drops Or Distil Water- Patient suffering with mild to moderate fungal infection is considered for once or twice a day ear wash with normal saline. These patients complain of mild pain and ear discharge is serous and not purulent.
- Removal of Ear Wax- During initial stages of ear fungal infection, it is better to remove the wax from external ear. Removal of wax helps antifungal medication to work better
- Warm Water- Pour warm water in ear until external ear is filled with water. Turn the head so liquid flows out of ear and make sure pillow is covered with disposable towel. Repeat the procedure 2 times a day for 3 days. The wax will get softer and fall off from ear.
- Spray Water In External Ear Under Gentle Pressure- In some cases wax may not fall as it may be stuck to skin of external ear. In such cases warm water is squirt in external ear with gentle pressure. If Individual is complaining of pain, then stop the procedure. Pain suggests possibly to much pressure over the ear drum. Repeat procedure next day. The wax will be squeezed out after few attempts.
- Wax Softener- If wax is thick and not separating from its attachment to ear skin then use wax softener like Debrox or Murine is used. Debrox or Murine drops are squeezed in external ear on diseased side 3 times a day for 2 to 3 days. Wax softener drops are available over the counter in most of the pharmacy. Make sure to fill the external ear with the drops.
Earache is treated with NSAIDs or Tylenol pills.
- NSAIDS- Non-Steroidal anti-inflammatory drugs like Motrin, Naproxen and Celebrex helps to relieve pain as well as inflammation caused by fungal infection.
- Tylenol- Tylenol helps to relieve mild to moderate ear pain caused due to Otomycosis.
Itching and pruritus is treated with antihistamines pills. The antihistamine drop does not help to relieve itching instead pills are prescribed. The antihistamine pills with least drowsiness are Zyrtec and Claritin that may help to relieve pruritus. Most patient suffering with pruritus are treated with Benadryl. Benadryl causes drowsiness.
- Gentian Violet Drops- Gentian violet is being used as an antifungal agent and helps to get rid of mild fungal infection during early stages. Gentian violet is antifungal and antibacterial dye.
- Antifungal ear drops- Clean the ear with normal saline solution or distil water. Then drop the antifungal ear drops in external ear. Antifungal ear drops recommended are clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate.3
- Antifungal pills- The oral pills prescribed includes triazole drugs, itraconazole, voriconazole, and posaconazole. These medications are effective in treating Candida and Aspergillus.3 The treatment become difficult if fungal infection of ear spreads in to cavity of mastoid bone.5
Home Remedies for Otomycosis or Ear Fungus
Given below are certain home remedies that are helpful in treating Otomycosis or Ear Fungus.
- Keep The Ear Dry- If you start feeling discomfort in ear then first thing you do is keep the ear dry. Moist external ear promotes fungal infections. Dry towel is used to remove the water from ear. You can blow warm air from hair dryer into external ear. You must be careful and not to blow very hot air. Keep at least 6 inches or more, between external ear and hair dryer blower to prevent forceful air passing into external ear. Avoid using cotton swabs. Cotton swabs can cause external ear skin laceration that may get infected.
- Rinse Ear with Vinegar and Alcohol Solutions- Fungus commonly develops in the warm and moist atmosphere of the ear canal. Applying alcohol not only helps in evaporating moisture but also dries and disinfects the skin. The acidity present in vinegar also helps in reducing the growth of fungus in the ear. You can mix equal quantity of alcohol and vinegar then pour the drops of mixture in external ear.
Prognosis for Otomycosis or Ear Fungus
Prognosis depends on the severity of disease.
- Prevent Severe Infection- Early diagnosis is important to prevent disease from becoming severe fungal infection. Most Otomycosis are misdiagnosed as bacterial infection and treatments are delayed. Such cases become severe fungal infection of Otomycosis. Symptoms of severe Otomycosis lasts for several months.
- Prevent Recurrence of Infection-The mild fungal infection is successfully treated with antifungal drops and pills. Recurrence is rare if disease is treated during early phase. Antifungal therapy helps greatly during mild and early stages of Otomycosis.
- Immunosuppress Individual- The fungal infection of ear become severe in stage rapidly in individual suffering with immunosuppression. In such cases aggressive therapy is necessary to prevent recurrence of Otomycosis.
- Severe Case of Otomycosis- Severe Otomycosis often become difficult to treat with medications. The complication like ear drum perforation results in prolonged disease and hearing loss.
- Otomycosis; clinical features, predisposing factors and treatment implications Khurshid Anwar1 and Muhammad Shahid Gohar2, Pak J Med Sci. 2014 May-Jun; 30(3): 564–567.
- Fungal Infections of the Ear in Immunocompromised Host: a Review Borlingegowda Viswanatha1 and Khaja Naseeruddin2, Mediterr J Hematol Infect Dis. 2011; 3(1):
- Otomycosis: Diagnosis and treatment. Vennewald I1, Klemm E., Clin Dermatol. 2010 Mar 4;28(2):202-11. doi: 10.1016/j.clindermatol.2009.12.003.
- Ho T, Vrabee JT, Yoo D. Coker NJ. Otomycosis: clinical features and treatment Implications. Otolaryngol Head Neck Surg. 2006;135(5):787–791.
- Otomycosis: clinical features and treatment implications. Ho T1, Vrabec JT, Yoo D, Coker NJ., Otolaryngol Head Neck Surg. 2006 Nov;135(5):787-91.