Otomycosis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Otomycosis: symptoms and treatment

Otomycosis is a disease caused by mold and yeast-like fungi. The middle and outer ear are affected. Sometimes the reproduction of the fungal form occurs after undergoing surgery. In the general structure of otitis media, otomycosis accounts for up to 18-26% of all infections. Moreover, both adults and children suffer with the same frequency. The danger of the disease lies in the fact that it is almost asymptomatic in the early stages of development. An infection is often detected only after serious complications have occurred.

Content:

• General information
• The causes of otomycosis
• Otomycosis symptoms
• Types and stages of otomycosis
• Otomycosis in children
• Diagnosis of otomycosis
• Otomycosis treatment
• Forecast and prevention

General information

From Latin, otomycosis is translated as ear fungus. This disease is contagious. It affects the ear canal.

Such representatives of the pathogenic flora can provoke an infection, such as:

• Candida.
• Rhisopus.
• A. fumigates.
• A. flavus.
• A. terreus.
• A. niger.

The infection can develop in both childhood and adulthood. At risk are people who live in countries with hot climates and high levels of humidity. Also at risk are people who go in for swimming, who often use headphones, and also have to wear hearing aids. Otomycosis is often diagnosed in patients who have undergone mastoidotomy.

Otomycosis in 90% of cases affects only one ear, that is, the infection is unilateral.

The causes of otomycosis

Otomycosis develops due to the fact that conditionally pathogenic flora begins to multiply in the ear. This leads to tissue inflammation, which negatively affects the condition of the hearing organ as a whole. Sometimes, in addition to fungal microorganisms, bacteria begin to multiply in the ear. This enhances the inflammatory response.

Normally, the fungi that cause otomycosis are always present on the skin of the ear. However, their growth is controlled by other microorganisms, so they do not lead to the development of the disease. In order for a person to develop ear inflammation, certain conditions are needed in which pathogenic microorganisms will feel comfortable.

The reasons that can lead to the occurrence of otomycosis:

• Ear injuries, accompanied by a violation of the integrity of the skin. This can occur both when physically affecting the skin of the ear, and when foreign objects get into it. Children often stick small details into the ear canal.
• Hyperhidrosis. This disorder is characterized by excessive sweating in various parts of the body. Some people experience increased perspiration in the parotid region. Hyperhidrosis refers to the individual characteristics of the body, but sometimes it can be triggered by a violation of metabolic processes.
• Underdevelopment of the ear canal of a congenital nature. It can be too narrow or overly flexible. This makes it difficult to clean.
• Taking some medicines. Therapy with antibiotics and steroid hormones can adversely affect, since they all contribute to a decrease in the immune system.
• Diseases of the body: HIV, diabetes, tuberculosis. All these pathologies negatively affect the state of human health.
• Work in hazardous industries. In terms of the occurrence of otomycosis, the danger is being in conditions with high levels of humidity, in cold and dusty rooms.
• Allergy to detergents, shampoo or hair balm. Any cosmetic formulation can irritate the skin.
• Ear furunculosis and otitis media. These diseases are accompanied by inflammation and negatively affect the condition of the skin, causing an imbalance in microflora.
• Accession of a secondary infection after otitis media, or after surgery (mastoidotomy). Surgical intervention is used when the mastoid process becomes inflamed. In the course of its implementation, the doctor opens the caves and cells of the mastoid process, carries out their drainage, and removes the purulent contents. If fungal flora enters the ear tissue during the operation, otomycosis will develop after a while.

Any factors that lead to a decrease in immunity contribute to the development of otomycosis.

Otomycosis symptoms

The symptoms of otomycosis depend on where the inflammation was concentrated:

• External otomycosis. The disease begins with the fact that the external auditory canal swells, the fatty film that protects it disappears. At this time, a person begins to experience congestion in the ear, it will itch from the inside. Most people do not go to a doctor with these symptoms, as they attribute them to a common ear plug. They try to remove it on their own, increasingly traumatizing the ear canal. Fungal flora can easily penetrate these microscopic lesions. It begins to multiply actively, resulting in increased inflammation. If it is very intense, the ear canal can be completely blocked, causing hearing loss. External otomycosis is accompanied by pain, which becomes more pronounced with eating and drinking.
• Mycotic otitis media. The cause of this inflammation is purulent otitis media. In this case, the fungal infection acts as a complication. The patient's state of health is impaired, the ear hurts badly, and pathological contents are released from it. Hearing worsens, noises appear in the ear.
• Fungal myringitis. This disease is characterized by the spread of infection to the eardrum. A person complains of hearing loss. This is due to the fact that the eardrum cannot make normal vibrational movements.
• Otomycosis after surgery. The inflammation is caused by ear surgery, such as mastoidectomy or tympanoplasty. After they have been carried out, it is necessary to use dressings for a long time. For disinfection, antibiotics and antiseptics are used, with which the bandages are impregnated. This leads to the fact that the natural microflora of the ear is disturbed. The disease is manifested by increased pain and an increase in pathological discharge.

Depending on which microorganism triggered the otomycosis, the symptoms of inflammation will vary:

• Ear discharge is dark in color when A. niger multiplies.
• The discharge from the ear turns dark yellow if the disease was caused by a fungus of the genus A. flavus.
• If the disease is provoked by fungi of the genus Candida, then the discharge has a cheesy consistency. The ear becomes covered with white crusts, which are first noticeable only in the ear canal, and then spread to the outer part of the ear, go beyond it, and can capture the hair growth zone. In its manifestations, the disease resembles weeping eczema.

The most dangerous fungi are members of the genus Mucor. They belong to molds that quickly colonize not only the ear, but also the nasopharynx. The patient suffers from dizziness and severe headaches. The complications of this infection can be very severe. Body temperature rises to febrile levels, retinal thrombosis develops. In such a situation, there is a risk of loss of vision.

Types and stages of otomycosis

Otomycosis can be of the following types:

• Outer. This form of otomycosis is diagnosed more often than others - in 20-50% of cases.
• Mycotic.
• Fungal myringitis. The defeat of the middle ear is observed in 10% of cases.
• Postoperative.

Depending on the characteristics of the course of the disease, several stages of the development of otomycosis are distinguished:

• Stage of precursors of inflammation. During this period, a person may experience a congestion in the ear. There are no other signs of the disease.
• Acute stage of the disease. A person develops pain in the ear, the external auditory canal swells, turns red, and discharge from the ear appears. The duration of the acute stage is no more than a month. If during this period it was not possible to cope with the disease, then it goes into a subacute phase, which lasts from a month to six months.
• Chronic stage. The inflammation does not give vivid symptoms, but it does not completely go away. The chronic stage of the disease lasts from six months or more.

Otomycosis in children

Violation of the natural balance of the microflora of the ear and a decrease in immunity leads to the fact that the child develops otomycosis. Moreover, children suffer from the disease more often than adults. The danger lies in the wrong diagnosis, which entails irrational treatment. This threatens the development of superinfection, which will be more difficult to cope with than with a common fungal disease.

Often, a fungal ear infection in children becomes a complication of a previous illness, such as otitis media. In older preschool and school age, mold otomycosis is more common. Babies are mainly diagnosed with candidal otomycosis.

Fungal inflammation can be triggered by factors such as:

• Undergoing radiation therapy or treatment with cytostatics.
• Use of topical corticosteroid medications.
• The use of antibiotics with a wide spectrum of action.

The symptoms of otomycosis in children are varied and depend on the severity of the inflammation.

Among them are:

• Ear congestion.
• Purulent discharge from the ear.
• Itching in the ear canal.
• Headache.
• Increased body temperature.
• Maceration of the skin of the ear canal.
• Earache.

The periods of remission are followed by periods of exacerbation. This happens when the treatment was not chosen correctly, or was absent altogether, and the disease turned into a chronic form. As a rule, in children, all symptoms appear more pronounced than in adults.

Diagnosis of otomycosis

To diagnose otomycosis, the doctor may prescribe the following types of examinations to the patient:

• Endoscopic examination.
• Mycological analysis.
• Taking X-rays.
• Microbiological analysis.

With otomycosis, the ear canal will be narrowed, it swells strongly, and liquid exudate comes out of it. In the discharge, you can see the accumulation of mycelium, but only under multiple magnification. Conducting analyzes allows you to determine the type of fungus, as well as select drugs to eliminate it.

Sometimes, in addition to fungal microorganisms, microbial flora is found in the collected material. In this case, treatment involves the use of antibiotics.

In addition to general diagnostic measures, the patient may be shown such types of examinations as:

• Audiometry (threshold and simple). In a simple examination, the doctor pronounces different phrases from the patient at a distance of 6 meters. The patient must repeat these phrases. Threshold audiometry involves the assessment of hearing using special equipment. The patient is put on headphones, in which he hears sounds of different tones and frequencies. For certain sounds, a person must press a button. This allows the patient's hearing to be assessed.
• Acoustic impedance measurement. This study allows you to assess the mobility of the tympanic membrane under the influence of sound waves and different pressures. For the procedure, a special insert with a probe is inserted into the ear.
• Otoacoustic emission. This test evaluates a child's hearing. A probe is inserted into the ear canal, which is equipped with a microphone and a recording device. A person will hear clicks during the diagnosis. Based on the vibrations of the eardrum, a graph is built that allows you to detect changes in hearing, if any.
• Evaluation of the patency of the auditory tube by blowing. No specialized equipment is required for diagnostics.
• Hearing assessment using a tuning fork. The person will hear sounds of different frequencies. This study allows you to evaluate the function of sound conduction and sound perception.

Otomycosis treatment

Based on the diagnostic data obtained, the doctor draws up a treatment regimen for otomycosis. First, it is required to treat the ear canal with disinfectants, after which antifungal agents are injected into it. The doctor performs the treatment in the office, and also gives recommendations for treatment at home. The patient may be prescribed drops, ointments, drugs for oral administration. A comprehensive treatment regimen allows you to quickly cope with the infection.

To eliminate inflammation and accelerate tissue regeneration, the patient can be prescribed physiotherapy. These include: EP UHF, inductometry, ultraphoresis with Prednisolone or Hydrocortisone. These corticosteroids can quickly eliminate pain, prevent fungal flora from multiplying, and relieve inflammation.

Drugs that can be prescribed to patients with otomycosis:

• Antifungal agents.
• Antibiotics.
• Ointments for the destruction of fungal flora.
• Ear drops that relieve unpleasant symptoms.
• Tablets with antifungal activity.

Ear hygiene

Regardless of what treatment was prescribed to a person, first you need to thoroughly clean the ear canal of all secretions, crusts, sulfur and other contaminants. To do this, use hydrogen peroxide, Maramistin or boric acid. Remove the discharge carefully using a cotton swab for this purpose.

The ear cleansing procedure must be carried out every time before medications are introduced into the ear canal.

With otomycosis, the ear is not warmed up or washed. Both water and warmth promote the growth of fungal flora. When a person takes a bath or shower, the ear canal should be covered with cotton wool. Ear hygiene is carried out according to the same rules for both children and adults. The exact dosage of the drug and the procedure for using the drugs should be checked with the otolaryngologist.

Medicines

Drugs for the treatment of otomycosis are selected after the cause of the inflammation is established and the causative agent of the disease is identified. As a rule, therapy is carried out on an outpatient basis. Hospitalization is rarely required, only in severe cases. The average duration of treatment is 1–2 weeks. The basis of therapy is antimycotics for oral administration.

Local ear treatment is carried out using solutions, ointments, creams and drops. If the need arises, the doctor prescribes antibacterial drugs to the patient. To increase immunity, the intake of vitamin and mineral complexes may be shown. If the patient has allergy symptoms, then he is prescribed a course of antihistamines.

When it is not possible to cope with the disease on an outpatient basis, the patient is hospitalized. An operation may be performed in the hospital.

Solutions

Healing solutions are used to treat the ears. Their use allows you to eliminate inflammation, as well as cope with fungal infection.

The most effective and most commonly prescribed solutions include:

• Candibiotic. The drug is injected into the ear canal to relieve inflammation, destroy the fungal flora and eliminate allergies. Its use can reduce the intensity of painful sensations. The solution is injected into the ear canal 3-4 times a day, 4-5 drops. After 3-5 days, the patient will notice an improvement. The course can last from a week to 10 days. Anuran is an analogue of Candibiotics.
• Nitrofungin 1%. This solution has a pronounced antifungal effect. The smell of alcohol comes from it. First, the solution is applied to cotton wool rolled into a tampon, and then inserted into the ear canal. Leave cotton wool in it for 2 hours. You need to perform the procedure 3 times a day. Treatment can be prolonged. It is completed after the patient has passed all the symptoms of the disease.
• Clotrimazole. This solution is used to treat fungal infections. It works for most of the mycotic flora. The drug is applied to a cotton swab and then inserted into the ear canal. The tampon is kept in the ear for 2-3 hours. The procedure is repeated 3 times a day. The course of treatment should last a month.

Ointments

There are many ointments for treating otomycosis. They are used externally.

The most effective drugs include:

1. Pimafukort. This is a complex ointment. Its use allows you to destroy not only the fungal microflora, but also bacteria. Also, Pimafukort has a pronounced anti-inflammatory effect. The ointment is applied to cotton wool rolled into a tampon and then inserted into the ear canal. You need to repeat these steps 2-4 times a day.
2. Lamisil. This ointment has a pronounced antifungal effect. It is active against most of the pathogenic flora that can cause inflammation in the ear. It is used to treat not only otomycosis, but also fungal infections of the mucous membranes, skin and nails. It is forbidden to prescribe the drug to lactating women and women in position. The ban is due to the fact that the active substances of the drug are able to penetrate into breast milk. Lamisil is used to treat otomycosis as well as Pimafukort.
3. Nystatin ointment. The drug has a pronounced antifungal effect. He very quickly destroys representatives of the Candida clan. Apply the ointment directly to the affected area. It should be applied in a thin layer. The procedure is performed 2 times a day. The course of treatment is a week, but the doctor can increase it up to 10 days.

Systemic drugs

It is not always possible to cope with local drugs in the treatment of otomycosis. Sometimes oral medications are required. They have an effect on the body as a whole, eliminating the inflammatory focus, destroying the fungal flora, as well as the symptoms of the disease.

The most effective drugs include:

• Amphotericin. It is an inexpensive and effective drug for treating fungal infections. It allows you to destroy most of the pathogenic flora. It is prescribed for the treatment of severe mycoses that affect deep tissues and pose a threat to human life.
• Diflucan. This medication contains the active ingredient fluconazole. Its reception allows you to destroy fungi of the genus Candida and mold fungi.
• Irunin. This drug has a broad spectrum of action, the effect is due to a substance called itraconazole. It destroys both opportunistic fungi and pathogenic flora. All dermatophytes, fungi of the genus Candida, mold fungi are "afraid" of him.
• Levorin. This drug allows you to fight the yeast-like fungi of the genus Candida. With otomycosis, it is taken at a dosage of 2,000,000 U / day. Treatment should continue for 10 days. It is important to adhere to the dose prescribed by your doctor. If it is exceeded, severe allergic reactions, skin irritation, and abdominal pain may occur.
• Nystatin. This drug acts on the cell membrane of the fungus, destroying it and leading to the death of the pathogenic flora. The daily dose is 3,000,000 units. The course of treatment lasts 2 weeks. Side effects that may occur during Nystatin therapy are diarrhea, nausea and even vomiting.
• Fluconazole. The drug is a triazole derivative. It has a broad spectrum of action and allows you to destroy 186 representatives of yeast of the genus Candida, but such varieties of fungal microorganisms as Candida glabrata and Candida krusei are resistant to it.

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Forecast and prevention

As a rule, antifungal therapy allows you to cope with a fungal infection quickly and fully. A relapse of the disease can happen only if a person has reduced immunity, or he does not follow medical recommendations.

In order to prevent the development of the disease, it is necessary to avoid getting water in the ears while bathing, not to be zealous with cleaning the sulfur. It should only be removed from the visible part of the ear canal. This will prevent the recurrence of the disease.

The author of the article: Lazarev Oleg Vladimirovich | ENT

Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)