Otomycosis (Oto = ear, mycosis = fungal infection) is the medical term for fungal infection of the ear canal. Otomycosis is quite common in Singapore as the climate here is hot and humid which predisposes the ear to fungal infection. Other predisposing factors are local irritation of the ear canal from cotton swabs or local trauma caused to the skin of the ear canal from objects used in attempting to clean the ear canal. The absence of the wax in the ear canal is also a predisposing factor. The ear wax is important as it protects the ear canal from fungal and bacterial infection by keeping the pH of the ear canal acidic between 4 and 5. Without the ear wax the pH rises and the ear canal is then predisposed to fungal infection. Frequent swimmers are also predisposed as with repeated water contact the ear wax is washed off with a drying effect in the ear canal. The common fungi that cause otomycosis are Aspergillus sp and Candida albicans sp.

Otomycosis_02

Otoscopy images of otomycosis taken with 4 mm 30 degree endoscope.

Patients typically present with severe ear pain, itchiness and blocked ears. The hearing may be muffled and sometimes there is discharge from the ears which may be blood stained. As the fungus tends to cause the skin epithelium to exfoliate the ear canal becomes full of a mass that looks like “wet newspaper” which is full of fungus and desquamated skin epithelium. Meticulous cleaning of the ear canal is the mainstay of the treatment. This is done with fine suction under microscopic guidance. The ear canal is meticulously cleared of debris and discharge. As the fungal infection can re-cur ear cleaning may be required several times a week. The patient is instructed to keep the ear dry and avoid scratching it with cotton wool buds. Application of Gentian Violet on the ear canal is useful as it has some antifungal properties and is used for fungal infections of the skin. Antifungal ear drops such as clotrimazole 1% ear drops (Canesten®) are prescribed.

 

Otomycosis

Otomycosis of the right ear canal.