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Otomycosis: treatment
Last reviewed: 23.04.2024
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[Indications for hospitalization
- Complicated forms of otomycosis of the ear.
- Labyrinth.
Non-pharmacological treatment of otomycosis
All kinds of physiotherapeutic effects in fungal otitis are contraindicated.
Medication otomycosis
To treat otomycosis of the ear is difficult. In this case, treatment is not always effective enough, despite the use of various antifungal drugs. This is due primarily to the specificity of the infectious process, since the opportunistic fungi of the genera Aspergillus, Candida and Penicillium 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 with a view to their possible elimination. If necessary, abolish antibiotics, conduct complex restorative treatment, vitamin therapy. Associated diseases such as diabetes mellitus, blood diseases, immunodeficiency conditions, gastrointestinal diseases and others should be identified and refer patients to treatment.
It is necessary to consider the role of allergy in the pathogenesis of otomycosis, since fungi have pronounced allergenic properties. Therefore, simultaneously with the treatment of otomycosis with antifungal agents, desensitizing therapy is advisable.
In the treatment of otomycosis most often used antifungal drugs such as ketoconazole, natamycin, fluconazole, itraconazole, amphotericin B, miconazole, terbinafine, nystatin, levorin.
The course of therapy with fluconazole is 10 days (once a day at doses of 50 mg or 100 mg). Terbinafine is taken 250 mg once a day for 14 days. The course of treatment with itraconazole is 14 days (100 mg once a day).
With local treatment of otomycosis, it is advisable to use the following drugs: chlornitrophenol, bifonazole, alcohol solution of oxyquinoline, miconazole, clotrimazole, natamycin suspension, terbinafine cream, aconazole. Clotrimazole and natamycin are advisable to use only with candidiasis lesions.
For a specific treatment of otomycosis, a local antifungal drug naftifin is recommended. Naphthyfine is the representative of a new group of compounds derived from allylamides. The antifungal properties of allylamines are due to the fact that they suppress the biosynthesis of ergosterol in fungi, that is, they have fungicidal effects. It is active against dermatophytes, mold fungi and fungi of the genera Candida, Aspergillus and Penicillium. This drug along with fungicidal has a good anti-inflammatory effect. This is especially important in otomycosis, accompanied by a pronounced inflammatory component, which causes frequent use of a combination of antifungal and glucocorticoid drugs.
An obligatory condition for the local antifungal treatment of otomycosis is preliminary careful cleaning of the ear from the pathological discharge. The ear toilet is produced only by a doctor using an attic probe and a tampon moistened with an antimycotic drug. A careful ear toilet is given special importance, since even a small amount of mycotic masses markedly increases the duration of treatment and, accordingly, delays recovery.
With external otomycosis, great importance is the cleaning of the antero-lower part of the external auditory canal. With medium mycotic otitis completely remove the mycotic masses from the perforation of the tympanic membrane. At large perforations, in order to remove the mycotic masses, the drum cavity is washed with antiseptic solutions of antifungal action, in particular 0.1% oxyquinoline alcohol, 0.01% myramistin solution. Similarly come in the treatment of mycosis of the postoperative cavity of the middle ear. Before the treatment, in the presence of polyps, granulations, they are removed or stewed with a 20% solution of silver nitrate. With postoperative fungal infection, the entire non-antiparinal cavity is thoroughly cleaned, especially in the posterior compartment, behind the spur.
Local treatment of otomycosis with antimycotic drugs should be carried out for at least 3-4 weeks under weekly laboratory monitoring. Local treatment is carried out by inserting into the ear of the cotton turund, moistened with a fungicidal preparation. Turundu 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 a complete clinical cure within 1 month, confirmed both by the clinical picture and negative results of mycological examination.
Further management
Proceeding from the fact that otomycosis is prone to recurrence, it is necessary to observe patients dynamically for 6 months and conduct a course of preventive treatment. For the purpose of prevention, once a week (within 4-6 weeks), lubricate the skin of the external auditory canal with antimycotics.
What is the prognosis of Otomycosis?
With timely treatment and adequate antifungal therapy of otomycosis, the prognosis is favorable.
Prevention of fungal otitis
The main measures to prevent 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 restorative therapy are necessary.