Otomycosis - a review of current management trends
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.
Keywords: otomycosis, otitis externa, management, antifungals