A Clinical Study of Otomycosis

Abstract

Otomycosis is a fungal infection of the external auditory canal; middle ear and open mastoid cavity that is frequently encountered by otolaryngologists. It presents with nonspecific symptoms of itching, earache, ear discharge, hearing loss, aural fullness, and tinnitus. Otomycosis is seen more frequently in immunocompromised patients as compared to immunocompetent persons. Recurrence rate is high in immunocompromised patients and they need longer duration of treatment and complications are more frequent in these patients. In recent years, opportunistic fungal infections are gaining greater importance as a result of possibly increasing number of immunocompromised patients. We performed mycological analysis of fungal debris from external auditory canal of 200 patients clinically diagnosed with otomycosis. The objectives of our study were to recognize the commonest mode of presentation, predisposing factors, categorize the fungal species, sex distribution, complications, and the treatment outcome both in the immunocompetent as well as immunocompromised patients. Methods: We conducted a prospective type of study which includes 200 cases of clinically diagnosed otomycosis, of which 60 patients were immunocompromised. After a detailed history and clinical examination, required investigations were carried out to confirm the diagnosis. All patients were treated with topical Clotrimazole and 20 of them who did not respond to it were treated with Fluconazole. The patients were followed up at the end of every week for 4 weeks for follow-up of relief of symptoms and clinical examination. Results: In this study, otomycosis was found to be more common among males(53%) and majority in the age-group 21-30 years(42%). The disease was predominantly unilateral(89%), but bilateral involvement was seen more in the immunocompromised group. Aspergillus species(77%) was the most commonly isolated fungus in the immunocompetent group while Candida(53.4%) was commonly isolated in the immunocompromised group. All the patients were treated with Clotrimazole eardrops. Twently of the immunocompromised patients who did not respond to it were successfully treated with Fluconazole. Six of the immunocompromised patients had TM perforation due to otomycosis. Conclusion: Otomycosis is fungal infection of the external ear and infrequently affects the middle ear. It presents with symptoms of itching, ear discharge, blocking sensation, and earache. The major predisposing factors for otomycosis are trauma to the EAC, use of ab/ab-s eardrops, and immunocompromised status. The disease is predominantly unilateral with bilateral involvement more in the immunocompromised patients. Aspergillus species and Candida are the most commonly isolated fungi among the immunocompetent and immunocompromised patients respectively. Otomycosis is successfully treated with topical Clotrimazole and Fluconazole. Complications occur in the immunocompromised patients.