Otomycosis: Difference between revisions
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*Also known as fungal otitis externa or "Singapore Ear" | *Also known as fungal otitis externa or "Singapore Ear" | ||
*A superficial [[fungal infection]] of the outer ear canal | *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<ref name="Munguia">Munguia R, Daniel SJ. Ototopical antifungals and otomycosis: a review. Int J Pediatr Otorhinolaryngol. 2008 Apr;72(4):453-9. doi: 10.1016/j.ijporl.2007.12.005. Epub 2008 Feb 14.</ref> | *Found in 9% of [[otitis externa]] cases, and as many as 30.4% of cases of symptoms of otitis<ref name="Munguia">Munguia R, Daniel SJ. Ototopical antifungals and otomycosis: a review. Int J Pediatr Otorhinolaryngol. 2008 Apr;72(4):453-9. doi: 10.1016/j.ijporl.2007.12.005. Epub 2008 Feb 14.</ref> | ||
*More common in tropical/subtropical countries. | *More common in tropical/subtropical countries. | ||
*Common causes: ''Aspergillus niger'' and ''Candida albicans''<ref name="Munguia" /> | *Common causes: ''[[Aspergillus]] niger'' and ''[[Candida albicans]]''<ref name="Munguia" /> | ||
*Risk factors: | *Risk factors: | ||
**Recent use of topical otic antibiotics | **Recent use of topical otic [[antibiotics]] | ||
**Topical or systemic steroids | **Topical or systemic [[steroids]] | ||
**Hearing aid use | **Hearing aid use | ||
**Pregnancy | **[[Pregnancy]] | ||
**Local trauma | **Local [[facial trauma|trauma]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Similar to [[otitis externa]], but with more itching than pain | *Similar to [[otitis externa]], but with more itching than pain | ||
*Characteristic appearance on exam - appears like "mold growing on spoiled food" | *Characteristic appearance on exam - appears like "mold growing on spoiled food" | ||
*Otalgia | *[[Otalgia]] | ||
*Otorrhea | *Otorrhea | ||
*Hearing loss | *[[Hearing loss]] | ||
* | *[[Pruritus]] | ||
*Tinnitus | *[[Tinnitus]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Ear DDX}} | {{Ear DDX}} | ||
== | ==Evaluation== | ||
*Clinical diagnosis, based on history and physical examination | *Clinical diagnosis, based on history and physical examination | ||
==Management== | ==Management== | ||
#Aural hygiene | |||
#Topical [[antifungal]] | |||
* | #*[[Clotrimazole]] - most effective agent (also has some antibacterial effect) | ||
* | #*[[Ketoconazole]] | ||
* | #*[[Fluconazole]] | ||
* | #*[[Nystatin]] | ||
#Add PO antifungal treatment if poor response to topical treatment or severe disease | |||
==Disposition== | ==Disposition== | ||
Latest revision as of 22:12, 30 September 2019
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[1]
- More common in tropical/subtropical countries.
- Common causes: Aspergillus niger and Candida albicans[1]
- 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
Internal
- Acute otitis media
- Chronic otitis media
- Mastoiditis
Inner/vestibular
Evaluation
- Clinical diagnosis, based on history and physical examination
Management
- Aural hygiene
- Topical antifungal
- Clotrimazole - most effective agent (also has some antibacterial effect)
- Ketoconazole
- Fluconazole
- Nystatin
- Add PO antifungal treatment if poor response to topical treatment or severe disease
Disposition
- Discharge