In the recent past, I have been seeing a large number of cases of otomycosis or in simple terms fungal ear infection. The number of cases has peaked drastically in the last 3 months during the partial and complete COVID-19 lockdowns happening in India. The most common question that all these patients have been asking me is " Why am I getting a fungal infection in my ears?".
Otomycosis or fungal infection of the ear can affect one or both ears. It can be caused by 60 various species of fungi although the most common species is the Aspergillus and Candida. To make things worse, superadded bacterial infections can simultaneously appear with otomycosis. It is more common in tropical or hot humid parts of the world as fungi require warmth and moisture to grow.
FACTORS PREDISPOSING OTOMYCOSIS
Absence of wax or cerumen
Humid climate
Increased temperature
Instrumentation of the ear
Long term use of antibiotics/steroid ear drops
Among these factors, one of the most common predisposing factors that have been noticed in my practice is the instrumentation of the ear. In other words, individuals attempting self-cleaning of ears at home with objects such as q-tips or cotton buds, fingers, wooden sticks, hairpin, key, etc. This observation has been documented in multiple studies that have been done in the past. Swimming also has been observed as a predisposing factor.
The removal of wax or cerumen by self-cleaning eliminates the protective function provided. Cerumen serves as a protective coating to trap dust and repelling water. Its acidic nature helps in making an unsuitable environment for bacterial and fungal growth.
COMMON SYMPTOMS
Ear pain
Itching
Fullness of the ear
Ear discharge
Redness
Flaky or dry skin
Swelling or inflammation
Ear block or hearing difficulty
Symptoms can develop in one ear or both ears. The symptoms are usually mild in the initial phase but if ignored, tend to aggravate into severe pain and discomfort.
TREATMENT
Otomycosis is easily diagnosed by a doctor with a basic ear examination. Once diagnosed, the ear requires a thorough cleaning of the ear to remove all the fungal elements and spores. Ear cleaning or aural toileting can be done using suction or cotton swab or syringe. In more severe cases, aural toileting may not be accomplished adequately due to the edema or swelling of the ear canal. In such cases, ear wicks or packs coated with steroids and antifungals are used to pack the ear.
In my experience, ear packing and more frequent aural toileting significantly help in faster recovery. It is also essential to keep a close watch and good control of co-morbidities like diabetes to avoid serious complications of otomycosis. Aural toileting may be slightly uncomfortable for the first time but provides significant relief to the patient once completed.
Once the aural toileting is done, suitable topical preparations or ear drops will be prescribed for 2 weeks. During these 2 weeks, strict ear precaution has to be taken to avoid any water entry into the ears. Water sports and swimming has to be avoided. It is always advisable to revisit the treating doctor after 2 weeks to ensure complete eradication of the fungus to avoid recurrent infection.
I ALWAYS ADVISE MY PATIENTS TO LET THE EAR DO ITS JOB AND STOP DISTURBING IT WITH YOUR FINGERS, KEYS, OR COTTON BUDS.
REFERENCES
1. Latha R, Sasikala R, Muruganandam N. Chronic otomycosis due to Malassezia spp. J Glob Infect Dis. 2010;2(2):189-190. DOI:10.4103/0974-777X.62875
2. Aremu SK, Adewoye KR, Ibrahim T (2020) A Prospective Analysis of Otomycosis in a Tertiary Care Hospital. Int J Trop Dis 3:029. doi.org/10.23937/2643-461X/1710029
3.Tammy Dowdell Ream, Chapter 32 - Removal of Cerumen and Foreign Bodies from the Ear, Essential Clinical Procedures (Second Edition),
W.B. Saunders,2007, Pages 445-452,
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