Otolaryngology Book

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Fungal Otitis ExternaAka: Otomycosis, Jungle Ear

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  1. See Also
    1. Chronic Otitis Externa
  2. Epidemiology
    1. Accounts for 10% of Acute Otitis Externa cases
    2. More common cause of Chronic Otitis Externa cases
  3. Etiology
    1. Aspergillus niger (80 to 90% of cases)
      1. Black exudate
    2. Candida albicans (second most common cause)
      1. Cheesy white exudate
    3. Actinomyces
    4. Trichophyton
  4. Risk Factors
    1. Extremely moist, hot environments
    2. Chronic Bacterial Otitis Externa
  5. Symptoms
    1. Significant Ear canal pruritus more than pain
    2. Sensation of ear fullness
    3. Protracted course of Otitis Externa
  6. Signs
    1. Whitish-grey, yellow or black canal exudate
    2. Looks like a Fungal Cave
    3. EntOtomycosis.jpg
  7. Differential Diagnosis
    1. Otitis Externa
  8. Labs
    1. Potassium Hydroxide (10% KOH)
      1. Fungal hyphae on slide
  9. Management
    1. See Otitis Externa for General measures (Ear toilet)
      1. Cleaning and debriding ear is paramount
    2. Otitis Externa Topical Medications
      1. Ear canal acidification
        1. Otic Acetic Acid 2% qid for 5 to 7 days
        2. Alcohol and White Vinegar 1:1 mix as drops in ear
      2. Topical Antifungals
        1. Indicated if acidification not effective
        2. Preparations: Intact Tympanic Membrane
          1. Clotrimazole (1%) Lotrimin drops
          2. M-cresyl acetate (Cresylate)
        3. Preparation: Tympanic Membrane Perforation
          1. Tolnaftate 1% Solution (Tinactin)
      3. Systemic Antifungal
        1. Indicated for refractory Aspergillus infection
        2. Preparation: Itraconazole (Sporanox)
    3. Oral Analgesics for 48 hours
  10. Prevention: Keep ears dry
    1. Instill Alcohol in both ears and let drain qhs
    2. Apply moisturizing cream to edge of ear canal in AM
  11. References
    1. Bojrab (1996) Otolaryngol Clin North Am 29:761
    2. Halpern (1999) J Am Board Fam Pract 12(1):1
    3. Lucente (1993) Otolaryngol Clin North Am 26:995
    4. Mirza (1996) Postgrad Med 99:153
    5. Sander (2001) Am Fam Physician 63:927

Otomycosis (C0029895)

ConceptsDisease or Syndrome (T047)
EnglishOtomycosis
Spanishotomicosis
Parent ConceptsUnspecified infective otitis externa (C0021355), Fungal ear infection (C0729545), Duplicate concept (C1274013)
SourcesDXP, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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