Microascus gracilis y otomicosis

Microascus spp, teleomorfo de Scopulariopsis, es un hongo saprofito encontrado normalmente en suelo, alimentos, vegetales e incluso en ambientes interiores. Considerado un contaminante ambiental, se caracteriza por la resistencia intrínseca a los antifúngicos disponibles. Existen escasas referencias de infecciones por Microascus gracilis, asociándose como causa de eumicetoma o enfermedad diseminada en pacientes sometidos a trasplante pulmonar. Presentamos un caso de otomicosis por M. gracilis con el fin de considerar la búsqueda de hongos en los cultivos óticos y poner de relevancia el poder patógeno y colonizador de este agente.

Microascus spp, a teleomorph of Scopulariopsis, is a saprophytic fungus normally found in soil, food, vegetables, and even indoors. Considered an environmental pollutant, it is characterized by its intrinsic resistance to available antifungals. There are few references to infections by Microascus gracilis, associating it as a cause of eumycetoma or disseminated disease in lung transplant recipients. We present a case of otomycosis caused by M. gracilis, to consider the search for fungi in ear cultures and highlight the pathogenic and colonizing power of this agent.

Clinical presentation and fungal species distribution in otomycosis in a tertiary care hospital

Objective: Otomycosis is a common fungal ear infection in tropical and subtropical regions worldwide. This study aimed to perform mycological analysis on fungal debris from the external auditory canals of the patients to study the most common clinical presentation and fungal species distribution in otomycosis. Materials and Methods: Patients who met the inclusion criteria for this cross-sectional study were included and evaluated after providing written informed consent. After obtaining a thorough medical history, ear swabs for culture, sensitivity, and potassium hydroxide were provided. Patients with positive culture results were studied between September 2019 and March 2021. Results: Among 103 cases observed for 18 months in the Department of ENT, Rajarajeswari Medical College, and Hospital, Bengaluru, India, we found that males (56.31%) were more affected than females (43.68%). Itching (67.96%) was the most primary and common symptom that was observed, followed by pain (20.38%), and the most common predisposing factor was the usage of earbuds (26.21%) followed by water in the ear (23.3%) and oil in the ear (16.50%). Unilateral infection was most common (96%), and the left ear was most affected (64.07%). Aspergillus niger was the most common fungal isolate (60.19%), and otomycosis was very common in postmonsoon (October–December) (58.25%). Conclusion: The most frequent fungal isolates in otomycosis are from the Aspergillus and Candida species. The left ear was typically affected by otomycosis, which frequently had a unilateral predominance. The most common clinical symptoms were itching and pain.

COMPARISON OF THE RECOVERY RATE OF OTOMYCOSIS USING CLOTRIMAZOLE DROPS, CLOTRIMAZOLE CREAM AND 10% POVIDONE IODINE SOLUTION (BETADINE) IRRIGATION.

Otomycosis is one of the common conditions encountered in ENT practice. Difference of opinion does exist regarding ideal treatment modality. Compare the efficacy of 1% clotrimazole drops, 1% cl Aim: otrimazole cream and 10% betadine irrigation in the treatment of otomycosis. Randomized control study conducted in the Method: department of ENT and Head and Neck surgery of Government Medical College Baramulla. The study was conducted on 80 patients over a period of 6 months, clinically diagnosed with otomycosis. Patients were randomly allotted to three groups. Improvement in symptoms of pruritis, pain and blocked sensation on 1st, 2nd, 3rd and 4th follow up visits was recorded. All patients were asked the opinion about preferred treatment modality. When compared the Results: symptoms on day one and subsequent follow ups, the change in symptoms in all the groups was significant. Group 2 with 1% clotrimazole cream had significant improvement on first visit only. By 4th visit all the groups had significant improvement

Efficacy of 7.5% povidone-iodine and 1% clotrimazole in the treatment of otomycosis – A prospective randomized study

Background: Otomycosis is a common condition of the external auditory canal. Aspergillus species and candida species are common causative agents for otomycosis. Clotrimazole is effective in controlling candida species than Aspergillus species. The povidone-iodine is a routinely used antiseptic solution in surgical care. Aims and Objectives: To assess the efficacy of 7.5% povidone-iodine and 1% clotrimazole in the treatment of otomycosis. Materials and Methods: This prospective randomized study recruited 128 cases of both genders. The study participants were randomly divided into two groups. Group 1 received 7.5% povidone-iodine and group 2 received clotrimazole (1%). After removal of otomycotic debris, the study cases were randomly administered with study drugs three drops once a day. All the cases were strictly advised to adhere to the treatment procedure not <2 weeks. Descriptive statistics and Chi-square test was used to test the significance of qualitative data by SPSS 16.0. The P < 0.005 was considered as statistically significant. Results: After 14 days treatment, 1% clotrimazole group, showed continuous ear discharge (6.25%), pruritus (3.12%), tinnitus (3.12%), otalgia (1.56%), and deafness (1.56%), which was higher than 7.5% povidone-iodine group. Aspergillus niger (1 case) and Aspergillus flavus (2 cases) isolates were observed in 1% clotrimazole group. Good treatment response after the 5th day was seen in 15.62% and 18.75% cases, after the 9th day in 45.31% and 48.43%, and after the 14th day in 87.5% and 75% in 7.5% povidone-iodine and 1% clotrimazole groups, respectively. Conclusion: The cases treated with 7.5% povidone-iodine were showed comparatively less bacterial and fungal isolates and less clinical signs and symptoms than cases treated with 1% clotrimazole after 2 weeks of treatment follow-up.

Efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone-iodine in the treatment of otomycosis - A randomized controlled study

Introduction: Otomycosis is a term used to describe the epithelial infection caused by yeast and filamentous fungi, in the External Auditory Canal (EAC). It is one of the common infections seen in ENT OPD because of its prevalence in hot and humid climate. Due its high recurrence rate and different treatment modalities, it’s important to come out with ideal treatment modality. Aim: To compare efficacy of 1% clotrimazole drops vs. 1% clotrimazole cream vs 10% povidone- iodine in the treatment of otomycosis. Materials and methods: Randomized control study was performed for 2 months on clinically diagnosed otomycosis patients. Total 60 patients were included in the study, which were randomly divided in 3 groups and treated by 1% clotrimazole drops, 1% clotrimazole cream and 10% povidone- iodine respectively. Patients were reviewed after 7 days on the basis of clinical response and symptoms of pain, ear blockage, pruritus and burning sensation. Results: After 7 days of treatment groups treated with 1 % clotimazole drops and cream had good response of 90% and 95% as compared to 10% povidone-iodine group which was 70%. Clotrimazole cream group had more ear blockage complain which was 75% and clotrimazole drops group had more burning sensation complain which was 55%.Conclusion: 1% clotrimazole drops and cream are equally effective in management of otomycosis but 10% povidone-iodine can be considered if patient has complain of ear blockage and burning sensation.

Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial / Eficácia do clotrimazol tópico versus tolnaftato tópico no tratamento da otomicose: um ensaio clínico controlado randomizado

Abstract Introduction: Otomycosis, an infection of the ear canal by fungi, is prevalent in hot and humid weather. Nevertheless, there is not sufficient evidence for the effectiveness of different topical antifungal treatments. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Currently there are not sufficient studies that prove its efficacy. Objectives: To compare the efficacy of clotrimazole and tolnaftate administration in the treatment of otomycosis. Material and methods: A controlled, randomized and open clinical trial included patients diagnosed with fungal external otitis who were treated with topical antifungals, randomized into two treatment groups: (1) clotrimazole cream; (2) tolnaftate solution. They were microscopically evaluated at one and two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed. Follow-up and final outcomes (absence of infection) were compared between groups. Results: Forty eight patients were included, 28 in the clotrimazole group and 20 in the tolnaftate group. Spring was the weather most commonly associated with otomycosis, while otic manipulation was the risk factor more common in both groups. Predominant symptoms were itching and otic fullness. Aspergillus niger organism was isolated most frequently. Treatment with clotrimazole resulted in 75% resolution vs 45% resolution with treatment with tolnaftate at one week of treatment (p = 0.007). The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures, 20% and 15% respectively. Conclusions: Clotrimazole cream treatment is more effective than tolnaftate for uncomplicated otomycosis. More studies are needed to corroborate our results.

Resumo Introdução: Otomicose, uma infecção fúngica do canal auditivo externo, é prevalente em climas quentes e úmidos. No entanto, a literatura não apresenta evidências suficientes sobre os diferentes tratamentos antifúngicos tópicos. O tolnaftato é um antifúngico tópico descrito como eficaz no tratamento da otomicose; entretanto, sua eficácia não está suficientemente comprovada. Objetivo: Comparar a eficácia do uso de clotrimazol e tolnaftato no tratamento da otomicose. Material e método: Ensaio clínico controlado e randomizado; incluiu pacientes diagnosticados com otite externa fúngica tratados com antifúngicos tópicos, randomizados em dois grupos de tratamento: 1) clotrimazole (creme); 2) solução de tolnaftato. Eles foram avaliados microscopicamente uma e duas semanas após o início do tratamento para avaliar a resolução da doença. Recorrência e intercorrências foram registradas; além disso, as variáveis demográficas e clínicas foram coletadas e analisadas. Os dados do acompanhamento e desfechos finais (ausência de infecção) foram comparados entre os grupos. Resultados: O estudo incluiu 48 pacientes, 28 dos quais foram alocados ao grupo clotrimazole e 20 ao grupo tolnaftato. A primavera foi a estação mais comum; a manipulação foi o fator de risco mais comum em ambos os grupos. Os sintomas mais comuns foram coceira e plenitude auricular. Aspergillus niger foi o micro-organismo mais comumente isolado. Após uma semana, o tratamento com clotrimazol apresentou uma taxa de resolução de 75% vs. 45% com o tratamento com tolnaftato (p = 0,007). O tratamento com tolnaftato apresentou maiores taxas de recidiva e falhas: 20% e 15%, respectivamente. Conclusões: Em casos de otomicose não complicada, o uso de clotrimazol (creme) é mais eficaz do que o de tolnaftato. Mais estudos são necessários para corroborar os presentes resultados.

Assessment Of Risk Factors And Identification Of Fungal And Bacterial Agents In Otomycosis At Rural Community Attending A Tertiary Care Hospital

Introduction: Otomycosis is a sub-acute or a chronic superficial fungal infection of the external auditory canal.It is one of the frequently encountered fungal infections of the ear. The prevalence of otomycosis is higher intropical and subtropical climates zones. This study was planned to identify the most common organismsinvolved in otomycosis, clinical features and various predisposing factors of the disease in south India.Materials and Methods: Prospective study on 187 confirmed cases of Otomycosis who attended the ENT OPD. Apredesigned proforma was administered to the participants to know the clinical symptoms, predisposingfactors, sociodemographic details, and comorbid conditions. Clinical findings in both ears were recorded.Results: The majority of the study population (31%) were in the age group of 31-40. Around 47% of the studypopulation had a history of manipulation of the external auditory canal. Around 32 % gave the history of theinstallation of either antibiotic drops or steroid drops into the ear. Around 97% of the study population hadblocked, 83% had pain and 77 % had itching. The discharge was present in 47% of the study population. Femaleprevalence was high and more than 88% was unilateral. Aspergillus species and Candida species were morecommonly present in the fungal culture. Around 88% had a bacterial infection along with fungal growth.Conclusion: the diagnosis of Otomycosis must be considered for all cases of ear discharge for prompt andaccurate treatment and to save time and suffering.

Comparison of response to treatment of otomycosis using topical betadine and clotrimazole drops

INTRODUCTION:Otomycosis is the fungal infection of EAC (External Auditory Canal) that is very commonly seen in Ear , Nose and Throat clinics .Local debridement and antifungals , topical or systemic is the treatment of choice but recurrences are very common and resistant to treatment.METHODS:Total 220 patients, divided into two groups each 110 in 'A' and 'B' were subjected to betadine (povidone - iodine )10% solution and Clotrimazole (1 %) drops treatment and response of treatment assessed on 5th , 10th and 20th day and analyzed.RESULTS :Out of 110 patients in each group on 5th day 21.8 % patients in group 'A', and 23.6 % in group B' showed no response. 70.9 % in group 'A' and 72.7 % in group 'B' were showed good response at evaluation of 20th day of treatment.CONCLUSION :In our study, betadine (10% solution) and Clotrimazole (1 %) drops were equally effective in treatment of otomycosis. Betadine(10% solution) is low cost, non-ototoxic, nonresistant and equally effective in bacterial and fungal infection. That's why this study support betadine 10% solution as treatment of choice for otomycosis specially in developing countries

Literature Review on Patient Demographics, Risk Factors and Causative Agents of Otomycosis

Background: Otomycosis can be defined as a fungal infection of the external auditory canal, frequentlyencountered in the general otolaryngology department. Otomycosis is more commonly reported in hot andhumid climates and various individual as well as environmental factors predispose to this infection. Otomycosisis not only a prevalent condition but also follows a set patterns in patient demographics, predisposing factorsand, causative pathogens, which we aim to explore in this review. Objectives: In this review, we intend to shedlight on the prevalence of otomycosis, along with the characteristics of patients that are most commonlypresented with this condition including age, gender, occupation, socioeconomic class, as well as complains. Wealso aim to elucidate the various predisposing risk factors that increase the likelihood of contracting otomycosisand explore the usually encountered pathogenic causes. Materials and Methods: A review of relevant articlespublished between the years of 1975 to 2019 in English language was done using the databases of PubMed Pico,Google Scholar and Google, using the predetermined keywords. Conclusion: Otomycosis is a prevalent fungalear infection mostly seen in young patients between the ages of 21-30 years. Otomycosis mostly involves oneear, and bilateral involvement is mostly observed in immunodeficient patients. The most frequently reported riskfactors include self-cleaning of ears with objects such as Q-tips, wooden sticks, metal pickers, instillation ofmustard oil in ears, undue use of antibiotic ear drops, and swimming. Otomycosis causative organism isespecially Aspergillus and Candida while concomitant bacterial infection can be seen in several cases ofotomycosis, the most common implicated bacteria being staphylococcus aureus. This literature reviewhighlights the need for education to eradicate the aforementioned predisposing risk factors to reduce theincidence of otomycosis.

Single Dose Topical Application of Clotrimazole for the Treatment of Otomycosis: Is This Enough?

BACKGROUND AND OBJECTIVES: To determine the efficacy of filling the external auditory meatus with 1% clotrimazole at a single visit for the treatment of otomycosis. SUBJECTS AND METHODS: This prospective study included 40 patients who were referred to our clinic with complaints of ear itching, pain, and fullness, and were diagnosed with unilateral otomycosis. After cleaning the mycotic hyphae from the external auditory meatus, the ear canal was filled with 1% clotrimazole, using an intravenous catheter and syringe. The patients received follow-up examinations on post-treatment days 7, 15, and 45. RESULTS: The follow-up otomicroscopic examinations revealed that 95% of the ear canals were entirely clean and that all symptoms had resolved. The post-treatment scores of pain, aural fullness and itching were significantly lower than the pre-treatment scores (p < 0.01). CONCLUSIONS: Filling the external auditory meatus with 1% clotrimazole at a single visit is an easy, efficient, and cost-effective treatment for otomycosis. Additionally, high patient compliance makes this treatment superior to long-term topical therapy.

Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience

Abstract Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.

Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment / Comparação da taxa de recuperação de otomicose com o uso de tratamento tópico com betadina e clotrimazol

Abstract Introduction Otomycosis is a common diseases that can be associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be challenging, and requires a close follow-up. Treatment options for otomycosis include local debridement, local and systemic antifungal agents and utilization of topical antiseptics. Objective This study was designed to compare the recovery rate of otomycosis using two therapeutic methods; topical betadine (Povidone-iodine) and clotrimazole. Methods In this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p < 0.05. Results The results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole showed a good clinical response to treatment (p = 0.75). A good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p = 0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p = 0.46) in the groups treated with betadine and clotrimazole, respectively. The response to treatment was thus not significantly different in the two groups. Conclusion In the present study the efficacy of betadine and clotrimazole was the same for the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in otomycosis treatment, helping to avoid the emergence of resistant organisms.

Resumo Introdução A otomicose é uma das doenças comuns associadas a muitas complicações, como envolvimento da orelha interna e mortalidade em casos raros. O tratamento da otomicose pode ser realmente desafiador e requer um acompanhamento rigoroso. As opções de tratamento para otomicose podem incluir desbridamento local, agentes antifúngicos locais e sistêmicos e uso de antissépticos tópicos, os medicamentos tópicos recomendados para o tratamento da otomicose. Objetivo Comparar a taxa de recuperação de otomicose utilizando dois métodos terapêuticos de betadina tópica (povidona-iodo) e clotrimazol. Método Neste ensaio clínico simples cego, 204 pacientes com otomicose foram selecionados utilizando-se método de amostragem de não probabilidade conveniente e randomizados para dois grupos de tratamento, com betadina tópica e com clotrimazol (102 pacientes em cada grupo). A resposta ao tratamento foi avaliada aos 4, 10 e 20 dias após o tratamento. Os dados foram analisados utilizando o teste t independente, qui-quadrado e teste de Fisher no software SPSS v.18, com nível de significância de p < 0,05. Resultados Os resultados mostraram que dos 204 pacientes com otomicose, os tipos de fungos isolados incluíram Aspergillus em 151 casos (74%) e Candida albicans em 53 pacientes (26%). No quarto dia após o tratamento, 13 pacientes (13,1%) no grupo tratado com betadina e 10 pacientes (9,8%) no grupo tratado com clotrimazol apresentaram boa resposta ao tratamento (p = 0,75). Uma boa resposta ao tratamento foi relatada para 44 (43,1%) e 47 pacientes (46,1%) no décimo dia após o tratamento (p = 0,85); e 70 (68,6%) e 68 pacientes (67,6%) no vigésimo dia após o tratamento (p = 0,46) no grupo tratado com betadina e clotrimazol, respectivamente. Assim, a resposta ao tratamento não foi significativamente diferente nos dois grupos. Conclusão No presente estudo, a eficácia da betadina e do clotrimazol foi a mesma no tratamento da otomicose. O resultado deste estudo apoia o uso de betadina como um antifúngico eficaz no tratamento da otomicose que pode ajudar a evitar o surgimento de organismos resistentes.

Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

Clinical profile of Otomycosis: a hospital based study at central terrain region of Nepal

Background and Objectives: Otomycosis is the fungal infection of ear with some complications involving middle ear cavity and mastoid cavity. It is one of commonly encountered problem in otolaryngology clinics. It is commonly present in hot, humid with moisture, high temperature. So, this research is to study the clinical profile of otomycosis in central terrain region of Nepal.Material and Methods: The study was conducted in department of ENT- head and neck surgery in Janaki medical college and teaching hospital from August 2015 to June 2016. All the clinically diagnosed cases were enrolled in the study with typical symptoms and characteristics fungal debris in the external auditory canal (EAC). All the data regarding age, sex, occupation, presenting complaints, type of fugal debris, presence of acute otitis externa, findings of tympanic membrane (TM) taken.Results: Total of 77 patients were enrolled. Among them 27(35.1%) were male and 50(64.9%) were female. The most common presenting complaint is itching followed by earache, ear discharge, hearing loss. Itching was present in 77.9% of the cases followed by earache in 72.7%, aural fullness in 29%, ear discharge in 46.8% and hearing loss in 31.2%. Based on type of fungal debris on otoscopy, blackish was the commonest with frequency of 38 patients (49.4%) followed by whitish debris in 27 patients (35.1%) and yellowish among 12 patients (15.6%).Conclusion: Otomycosis is one of the most common presenting problems in otorhinolaryngology OPD. Females are affected more. Aspergillus niger implicated the most and ear itching is the most common presenting symptom.

Prevalance and Demographical Profile of Patients Presenting with Otomycosis.

Otomycosis is a widely prevalent and often underdiagnosed fungal infection of the ear that is commonly seen in the tropical and subtropical regions. We performed mycological analysis on the scrapings and debris taken from the external auditory canal of 97patients clinically suspected to have otomycosis. Male sex, young age group, rural background and rainy season emerged as the major risk factors. 37 patients were positive on KOH mount and 39 patients were positive when cultured on SDA medium. The prevalence of confirmed otomycosis was 40.2 ± 4.98 (95.C .I =30.44 -49.96). Smear positivity was found to have a statistifically significant relationship with the prevalence of positive cultures in patients presenting as otomycosis. Aspergillusniger and fumigatus were the major isolates.

Antifungal Effect of Malaysian Neem Leaf Extract on Selected Fungal Species Causing Otomycosis in In-Vitro Culture Medium

Azadirachta indica (neem) has been used for a long time in agricultural and alternative medicine. Neem had been proved effective against certain fungi that could infect human body. This pilot study aims to demonstrate the antifungal effect of Malaysian neem leaf extracts on the pathogenic fungi in otomycosis, Aspergillus niger and Candida albicans. This is a laboratory-controlled prospective study conducted at Universiti Sains Malaysia. The powder form of Malaysian neem leaf was prepared. Ethanol and aqueous extracts of the neem leaf was diluted with sterile water to establish five different concentrations of 50 g/ ml, 25 g/ml, 12.5 g/ml, 6.25 g/ml and 3.125g/ml. The extract was tested on Sabouraud Dextrose Agar suspended with Candida albicans and Aspergillus niger respectively. Well diffusion method was used and zone of inhibition was measured. Growth of the fungi was inhibited in both alcohol and aqueous extract concentrations. The minimum inhibitory concentration (MIC) of Malaysian neem aqueous extract against Candida albicans was 11.91 g/ml, neem ethanol extract against Candida albicans was 5.16 g/ ml, neem aqueous extract against Aspergillus niger was 7.73 g/ml and neem ethanol extract against Aspergillus niger was 9.25 g/ml. Statistical analysis showed that the antifungal activity of Candida albicans is better in alcohol neem than aqueous extract (p<0.001) but aqueous neem extract is better than alcohol extract (p<0.001) for Aspergillus niger.Malaysian neem has significant antifungal effect towards Aspergillus niger, best in aqueous extract and towards Candida albicans, was best in alcohol extract.

Fungal spectrum in otomycosis at tertiary care hospital.

Introduction: Otomycosis is a superficial mycotic infection of the external auditory canal that is caused by opportunistic fungi. It is a common fungal infection of the ear that is worldwide in distribution. The infection usually characterized by inflammation, pruritus, trauma to external auditory canal, scaling and severe discomfort such as suppuration and pain. We have tried to clarify the different causative factors & predisposing factors for otomycosis in our environment. Material & Methods: In this study we were including 100 patients (53 female and 47 male) with presumptive diagnosis of otomycosis. We performed mycological analysis on swab or fungal ball from external auditory canal of 100 patients. The diagnosis was confirmed micro biologically by direct microscopy (10% KOH mount) and fungal culture methods. Results: Otomycosis was more common among females as compared to males & also common in age groups of 20-35 yrs. The most common fungal pathogens isolated were Aspergillus niger (75.82%) followed by Aspergillus fumigatus( 13.19 %), Candida albicans ( 7.69 %) & Aspergillus flavus ( 3.3 %). while bacterial co infection/ super infection was detected in 6 cases. Conclusion: In this study we observe that otomycosis is unilateral condition more common in young age housewives and farmers particularly during summer and rainy season.

Otitis externa micótica y perforación timpánica: reporte de dos casos / Otomycosis and perforated tympanic membrane: two cases

La otitis externa constituye entre el 5 por ciento y 30 por ciento de las consultas de urgencia ORL y afecta al 10 por ciento de la población al menos 1 vez en la vida. La gran mayoría son de causa bacteriana, sólo el 15 por ciento a 20 por ciento son atribuidas a hongos. Las complicaciones son poco frecuentes alcanzando el 10 por ciento a 20 por ciento de los casos según la serie, siendo la perforación timpánica la más frecuente. Se presenta la evolución y tratamiento de 2 casos.

External otitis constitutes among 5 percent-30 percent of urgency ORL consultations and affects 10 percent of the population at least 1 time in their life. Most of them had a bacterial origin, only 15 percent to 20 percent are attributed to fungi. Otomycosis complications are slightly frequent reaching 10 percent to 20 percent of the cases according to diferent series, being the tympanic perforation the most frequent. We present 2 cases, their evolution and treatment.

A Clinicomycologic Study of Dermatophytosis of the External Auditory Meatus / 대한피부과학회지

BACKGROUND: Otomycosis is a mycotic disease of the external auditory meatus. Aspergillus is the most common pathogen. Despite the fact that a great number of fungi are considered as the cause of otomycosis, otomycosis due to dermatophytes occurs with great rarity. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of dermatophytosis in the external auditory meatus. METHODS: We performed a clinical and mycologic analysis of 17 patients who had been clinically and mycologically diagnosed with dermatophytosis of the external auditory meatus. In addition, amplication of TRS-1 and TRS-2 of the ribosomal DNA nontranscribed spacer was performed on strains of Trichophyton (T.) rubrum and T. raubitshcekii which were isolated from skin lesions of the external ear and cerumen in 6 patients. RESULTS: The ratio of male to female patients was 1.4:1. The age of patients were 6 to 72 and mean age of onset is 36.4. Eleven patients had concomitant dermatophytosis of other sites. Tinea unguium was combined in 7 cases, tinea pedis in 4 cases, tinea corporis in 3 cases, tinea manus in 2 cases and tinea cruris in 1 case. The positive rate of KOH examination was 88.2% and the positive rate of fungal culture on PDAC media was 88.2%. The most common organism cultured was T. rubrum (80.0%), followed by T. raubitschekii (13.3%) and T. mentagrophytes (7.7%). Ten patients were treated with topical terbinafine and seven patients with oral itraconazole, so all patients were cleared of fungi from the external auditory meatus and inflammation was resolved. With TRS-1 and TRS-2 amplication, 4 of 5 pairs of T. rubrum and 3 strains of T. raubitshcekii showed the same types regardless of the site in each patient. CONCLUSION: Dermatophytosis occurs rarely in the external auditory meatus but we experienced 17 cases of dermatophytosis at this site. With suspected otomycosis, dermatophytosis of the external auditory meatus and concomitant dermatophytosis must be investigated and treated simultaneously to prevent any recurrence.

Fungal Spectrum in Otomycosis Patients

Mycological analysis was carried out on debris, scraping or exudate samples from the external auditory canal(s) of 102 patients clinically suspected cases of otomycosis. The total number of samples taken from 102 patients were 108, of which 102 samples were obtained from one ear and 6 samples from the other ear. Predisposing factors contributing to such a presentation were dermatomycosis (51.22%), turban usage (29.26%), veil usage (14.63%) and swimming (4.88%). Only 82 (75.92%) samples were positive for the presence of fungal elements, of which 48(44.44%) specimens were smear and culture positive while 34(31.48%) were smear negative but culture positive. Males and females were almost equally affected, ratio being (1.1:1). Chief fungal isolates included Aspergillus niger (52.43%), Aspergillus fumigatus (34.14%), Candida albicans (11%), Candida pseudotropicalis (1.21%) and Mucor sp. (1.21%). Among 8 patients mixed fungal growth was obtained, while bacterial coinfection/ superinfection was detected in 14 cases.