Otomycosis in Shanghai: aetiology, clinical features and therapy

Abstract

Otomycosis is frequently seen in Shanghai and is a challenging problem due to recurrence and resistance to therapy. The aims of this study were to determine the pattern of fungal agents, sex distribution, clinical presentation, predisposing factors, complications and treatment outcomes of otomycosis. Retrospective review of 108 patients with a clinical diagnosis of otomycosis treated from September 2009 to September 2010 in otolaryngology outpatient department. It has been found to be more prevalent in female patients than male patients with a sex ratio (F : M) of 2 : 1. Aspergillus niger (54.78%) followed by Candida albicans (16.52%) were the dominant fungi. Pruritus and otorrhea were the most common presenting complaints. The predisposing factors included frequent scratching of the external ear canal (79.63%), taking ototopical and/or oral antimicrobials (24.07%), diabetes (11.11%) and otologic procedures (7.41%). Residual disease was observed in 9.26% and recurrence in 8.89% of the subjects. Topical Fluconazole ear drops and mechanical debridement of visible fungal elements in the external auditory canal were all relatively effective with 83.33% resolution rate on initial application. The diagnosis of otomycosis requires vigilance from clinicians given its non-specific symptoms. Sometimes mycological examinations are necessary. Treatment regimens such as topical fluconazole coupled with mechanical debridement are generally effective. However, recurrence is not uncommon and eradication of disease can be particularly difficult in patients with diabetes and a mastoid cavity.

Primary Otomycosis in the Indian Subcontinent: Predisposing Factors, Microbiology, and Classification

“…While some studies have reported otomycosis to be more common among young men [1, 5, 7, 8, 15] as in our series, many others have reported it to be so among young females [2, 3, 14, 16, 17]. In our series the male : female ratio was 1.7 : 1.…”

“…Obsessive manipulation of the external ear with any hard objects such as wooden sticks or metal wax picks to clean the ear of wax and vigorous rubbing of the ears for relief from itching (in case of otalgia due to eustachian catarrh, serous otitis, or acute otitis media) is a common practice. These practices may cause trauma (usually minor and hence unnoticed) to the skin of external auditory canal and deposition of fungal conidia in the wound leading to fungal infection [17]. The moisture, warmth, and acidic pH of the external auditory canal provide ideal growth requirements for the fungi.…”

Type of Antifungals: Does it Matter in Empirical Treatment of Otomycosis?

“…This disease is well prevalent in people coming from rural area surrounding our institution. There is a female predominance (59 %) in our study, which well correlates with the studies by Jia X [15] and Yehia MM [16]. The most common presenting complaint in our study is ear pain, which is same in Tang Ho study [10], but Kurshid Anwar coded hearing loss as the most common presentation in otomycosis [17].…”

Otomycosis: a clinical and mycological study

“…2 Clinical examination usually shows grayishwhite and black or cheese-like thick debris and inflammation of the outer ear. [3][4][5][6][7][8] Prevalence of disease was more in young adults with female predominance. The predisposing factors included wearing head clothes, hot weather, presence of dermatomycoses, dusty working environment and swimming.…”