II. Epidemiology

  1. Accounts for 10% of Acute Otitis Externa cases
  2. More common cause of Chronic Otitis Externa cases

III. 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

IV. Risk Factors

  1. Extremely moist, hot environments
  2. Chronic Bacterial Otitis Externa

V. Symptoms

  1. Significant Ear canal pruritus more than pain
  2. Sensation of ear fullness
  3. Protracted course of Otitis Externa

VI. Signs

  1. Whitish-grey, yellow or black canal exudate
  2. Looks like a Fungal Cave
  3. EntOtomycosis.jpg

VII. Differential Diagnosis

VIII. Labs

  1. Potassium Hydroxide (10% KOH)
    1. Fungal hyphae on slide

IX. 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

X. 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

Images: Related links to external sites (from Google)

Ontology: Otomycosis (C0029895)

Definition (MSH) Fungus infection of the external ear, usually by ASPERGILLUS species
Definition (MSHCZE) Mykotický, nejč. aspergilový zánět zevního zvukovodu. Při superinfekci pyogenními bakteriemi často zánět přechází až na chrupavku. Bubínek bývá zasažen vzácně. Onemocnění se projeví pruritem a vatovitým povlakem od žlutobělavé po zelenočernou barvu ve zvukovodu. Léčba spočívá v pravidelných výplaších a antimykotické lokální terapii. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Concepts Disease or Syndrome (T047)
MSH D059249
SnomedCT 275479004, 53316003
Italian Otite esterna micotica, Otomicosi
Japanese 真菌性外耳炎, シンキンセイガイジエン
Czech Mykotická otitis externa, otomykóza, ucho - mykotická infekce, otitis externa mycotica
Hungarian Gombás otitis externa
English Otomycosis, Otomycosis [Disease/Finding], Otitis externa fungal, Fungal otitis externa, Otomycoses, Otomycosis (disorder), Otomycosis, NOS, otomycosis
French Otomycose, Otite externe fongique
Portuguese Otomicose, Otite externa micótica
Russian ОТОМИКОЗ, OTOMIKOZ
Spanish Otomicosis, otomicosis (trastorno), otomicosis, Otitis externa fúngica
Polish Grzybica ucha zewnętrznego, Grzybica ucha, Otomikoza, Grzybicze zapalenie ucha
German Otomykose, Otitis externa durch Pilze
Norwegian Otomykose
Dutch otitis externa door schimmels