ABSTRACT Otomycosis is increasing in prevalence and can account for up to 20% of ENT outpatient consultations in warm and humid regions. Objectives: The aim of this review was to investigate the treatment strategies and antifungal agents used in various institutions and to highlight current trends. Design: PubMed, Cochrane Library and Google Scholar electronic databases were searched for freely-accessible articles spanning January 2001 and December 2020. Results: 59 full-text English-language articles were retrieved. Aspergillus spp. were the commonest species isolated followed by Candida spp. Clotrimazole-resistant Aspergillus spp. were encountered more frequently among immunosuppressed patients. Topical medications included drops, creams, ointments, powders, lotions and sprays. Systemic treatment was given orally or intravenously. Antifungal agents used were azoles, polyenes, echinocandin, allylamine, thiocarbamate, hydroxyquinoline and griseofulvin. Antiseptics employed included Betadine, Gentian Violet, N-chlorotaurine, Castellani’s Paint, Cresylate drops and Tincture Merthiolate. Steroids (beclomethasone, betamethasone, dexamethasone and hydrocortisone) were generally used in combination therapy. Acidifying agents administered were 3% boric acid, 2% acetic acid and 2% salicylic acid. Lignocaine and tetracaine formed part of some formulations. Conclusions: Topical applications are the mainstay of treatment of otomycosis, but occasionally oral or intravenous agents are required. Aural toilet and specific antiseptics have an important role. Clotrimazole remains an essential antifungal against a variety of fungi, but other antifungals may be needed against resistant species and in immunocompromised patients.