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Otomycosis - Treatment
Last reviewed: 04.07.2025
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[ Indications for hospitalization
- Complicated forms of otomycosis of the ear.
- Labyrinthitis.
Non-drug treatment of otomycosis
All types of physiotherapy are contraindicated for fungal otitis.
Medicinal treatment of otomycosis
Treating otomycosis of the ear is difficult. At the same time, treatment is not always effective enough, despite the use of various antifungal drugs. This is primarily due to the specificity of the infectious process, since opportunistic fungi of the genera Aspergillus, Candida and Peniсillium cause the disease only under certain predisposing conditions. When treating patients with otomycosis, it is necessary to take into account all possible factors in each specific case in order to eliminate them. If necessary, antibiotics are discontinued, complex general strengthening treatment and vitamin therapy are carried out. Concomitant diseases such as diabetes mellitus, blood diseases, immunodeficiency states, gastrointestinal diseases and others should be identified and patients should be referred for treatment.
It is necessary to take into account the role of allergy in the pathogenesis of otomycosis, since fungi have pronounced allergenic properties. Therefore, simultaneously with the treatment of otomycosis with antifungal drugs, it is advisable to conduct desensitizing therapy.
In the treatment of otomycosis, antifungal drugs such as ketoconazole, natamycin, fluconazole, itraconazole, amphotericin B, miconazole, terbinafine, nystatin, and levorin are most often used.
The course of fluconazole therapy is 10 days (once a day in doses of 50 mg or 100 mg). Terbinafine is taken at 250 mg once a day for 14 days. The course of itraconazole treatment is 14 days (100 mg once a day).
In local treatment of otomycosis, it is advisable to use the following drugs: chloronitrophenol, bifonazole, alcoholic solution of oxyquinoline, miconazole, clotrimazole, natamycin suspension, terbinafine cream, aconazole. Clotrimazole and natamycin are advisable to use only in case of candidal lesions.
For specific treatment of otomycosis, the local antifungal drug naftifine is recommended. Naftifine is a representative of a new group of compounds, derivatives of allylamines. The antifungal properties of allylamines are due to the fact that they suppress the biosynthesis of ergosterol in fungi, i.e. they have a fungicidal effect. It is active against dermatophytes, mold fungi and fungi of the genera Candida, Aspergillus and Penicillium. The named drug, along with fungicidal, also has a good anti-inflammatory effect. This is especially important in otomycosis, accompanied by a pronounced inflammatory component, which determines the frequent use of a combination of antifungal and glucocorticoid drugs.
A mandatory condition for local antifungal treatment of otomycosis is preliminary thorough cleaning of the ear from pathological discharge. Ear toilet is performed only by a doctor using an attic probe and a tampon soaked in an antifungal drug. Particular importance is attached to thorough ear toilet, since even a small amount of mycotic masses significantly increases the treatment time and, accordingly, delays recovery.
In external otomycosis, cleaning the anterior-inferior section of the external auditory canal is of great importance. In mycotic otitis media, mycotic masses are completely removed from the area of perforations of the eardrum. In case of large perforations, in order to remove mycotic masses, the tympanic cavity is washed with antiseptic solutions of antifungal action, in particular, 0.1% oxyquinoline alcohol, 0.01% solution of miramistin. The same is done when treating mycosis of the postoperative cavity of the middle ear. Before the start of treatment, if polyps or granulations are present, they are removed or extinguished with a 20% solution of silver nitrate. In case of postoperative mycosis, the entire neotympanic cavity is thoroughly cleaned, especially in the posterior section, behind the spur.
Local treatment of otomycosis with antifungal drugs should be carried out for at least 3-4 weeks under weekly laboratory control. Local treatment is carried out by inserting cotton swabs soaked in a fungicidal drug into the ear. The swab is left in the ear for 5-8 minutes, the procedure is repeated 4-6 times a day depending on the activity of the fungal process.
The criterion for the effectiveness of otomycosis treatment is considered to be complete clinical cure within 1 month, confirmed by both the clinical picture and negative results of mycological examination.
Further management
Based on the fact that otomycosis tends to recur, dynamic observation of patients for 6 months and a course of preventive treatment are necessary. For the purpose of prevention, it is necessary to lubricate the skin of the external auditory canal with antimycotic drugs once a week (for 4-6 weeks).
What is the prognosis for otomycosis?
With timely treatment and adequate antifungal therapy for otomycosis, the prognosis is favorable.
Prevention of fungal otitis
The main measures for the prevention of otomycosis should be aimed at eliminating the factors that are important in the development of fungal disease. Treatment with antibiotics and glucocorticoids should be rational, proper care of the external auditory canal, correction of the glycemic profile, and general strengthening therapy are necessary.