Administration of 1% topical voriconazole drops was effective and safe in the treatment of refractory otomycosis without tympanic membrane perforation.

BACKGROUND: Refractory otomycosis is a common condition that is difficult to treat. OBJECTIVES: This study aimed to evaluate the effectiveness of 1% topical voriconazole drops in the treatment of otomycosis. METHODS: This retrospective analysis was conducted from November 2017 to November 2019. Patients who had refractory otomycosis without tympanic membrane perforation confirmed by microbial culture and fluorescent staining were included in the study. All patients were treated with 1% topical voriconazole drops hourly at daytime for 2 weeks. Evaluation of effectiveness was conducted 1 month after the completion of topical voriconazole treatment. Before and after topical voriconazole treatment, hearing tests were performed in all patients. RESULTS: Fifty-five patients were included in this study. The reasons for refractoriness were resistant recurrence to imidazole drugs (50 cases, 90.9%) and difficulty in cleaning the external auditory canal (5 cases, 9.1%). The most common strain was Aspergillus terreus (50.9%), followed by Aspergillus flavus (29.1%), Aspergillus niger (10.9%), and Aspergillus fumigatus (9.1%). After 2 weeks of treatment with 1% topical voriconazole drops, otomycosis in all patients was resolved. There was no significant change in bone conduction before and after topical voriconazole treatment (paired t-test, P = 0.5023; linear correlation analysis, R2 = 0.98; equation, y = 1.003x-0.284). Adverse effects, such as blurred vision and phototoxicity, were not observed in any patient. CONCLUSIONS: Administration of 1% topical voriconazole drops was effective and safe in the treatment of refractory otomycosis without tympanic membrane perforation within 2 weeks.

The evaluation of endoscopic cartilage myringoplasty to repair perforations with otomycosis.

OBJECTIVE: We evaluated the graft success rates and hearing gains of tympanic membrane (TM) perforations with otomycosis undergoing endoscopic cartilage myringoplasty and local applications of antimycotic cream. STUDY DESIGN: A prospective case series. MATERIALS AND METHODS: In total, 74 persistent perforations with otomycosis who underwent cartilage myringoplasty were included. The pre-, intra-, and post-operative antimycotic cream were applied. The outcomes were the hearing gains and graft take rates at 6 months. RESULTS: At 6 months, the graft take rate was 83.8% (62/74). 6.8% developed postoperative purulent otorrhea and re-perforations; 9.5% recurrent otomycosis with re-perforations; and 4.1% mild postoperative otorrhea that resolved without re-perforation. The mean preoperative air-bone gap (ABG) was 32.31 ± 5.47 dB and the mean postoperative ABG 17.24 ± 4.95 dB, thus significantly different (p < .05). Of the 74 patients, 11(14.9%) had ABG closures within 10 dB, 48 (64.9%) had closures within 20 dB, and 15 (20.3%) had closures within 30 dB. We encountered no instances of graft lateralization or significant blunting during follow-up. CONCLUSIONS: Endoscopic cartilage myringoplasty effectively treats persistent perforations with otomycosis; however, pre-, intra-, and post-operative local applications of antimycotic cream are recommended.

Efficacy and safety of eberconazole 1% otic solution compared to clotrimazole 1% solution in patients with otomycosis.

PURPOSE: To demonstrate non-inferiority of eberconazole 1% otic solution to clotrimazole 1% solution, and to compare their safety profiles in the treatment of otomycosis. MATERIALS AND METHODS: Multicenter, randomized, double-blind, active treatment-controlled phase 3 clinical trial. One hundred and ninety patients with diagnosis of otomycosis were randomly assigned to eberconazole 1% otic solution or clotrimazole 1% solution. RESULTS: Baseline characteristics were comparable between both groups for age, gender, ethnicity, and clinical variables. Both study groups had high complete response rates: 81.8% in the eberconazole group and 83.5% in the clotrimazole group. Although non-inferiority of eberconazole relative to clotrimazole could not be demonstrated, a post-hoc sensitivity analysis demonstrated that eberconazole 1% otic solution was not inferior to clotrimazole 1% solution for the primary efficacy endpoint. Secondary endpoints also demonstrated that eberconazole 1% and clotrimazole 1% solutions were therapeutically similar at the end of the study. The incidence of adverse events was similar in both groups, and none had related AEs and withdrawals due to an AE. CONCLUSIONS: Eberconazole 1% otic solution is an efficacious and safe option to treat otomycosis-affected patients in the general practice.

[Otomycosis: the modern view of etiology and management]. / Otomikoz: sovremennyi vzgliad na étiologiiu i lechenie.

This article deals with the modern approaches to the diagnostics and treatment of fungal ear infection depending on the localization of the inflammatory process and the species of the causative fungal agent with special reference to the factors underlying the development of otomycosis under the present-day conditions based on the results of the analysis of the studies carried out during the period from 2010 to 2014. The materials of the examination of 2152 patients who applied for the medical care to various clinical departments of the Institute and were found to present with chronic inflammatory ear pathology were available for the analysis. Fungal lesions were diagnosed in 495 (23%) patients with this condition. Fungal lesions of the external ear were the predominant form of pathology; they were documented in 331 (67%) patients. Fungal otitis media was diagnosed in 85 (17%) patients and fungal lesions of the postoperative cavity in 79 (16%) patients suffering from otomycosis. 65% of the patients presenting with external fungal otitis, 20% of those with fungal otitis media, and 95% of the patients with inflammation of the postoperative cavity were infected with mold fungi dominated by the genus Aspergillus spp. 79 (16%) patients suffering from otomycosis. In 35% of the patients presenting with fungal external otitis, 80% of those with fungal otitis media, and 5% of the patients with inflammation of the postoperative cavity of the middle ear, the causative agents of the disease were the fungi Candida spp. The authors describe the modern schemes for the treatment of otomycosis elaborated at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology.

Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis - Our experiences at a tertiary care teaching hospital of eastern India.

INTRODUCTION: Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. MATERIALS AND METHODS: This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. RESULTS: There was no significance difference according to the age (P=0.134), gender (P=0.760) and causative agents (P=0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching (P=0.0001), otorrhoea (P=0.0033), fullness (P=0.0432) and earache (P=0.0259), whereas no statistical significant on hearing loss (P=0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema (P=0.0045), tragal tenderness (P=0.0012) and congestion of tympanic membrane (P=0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. CONCLUSION: Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment.

Epidemiology, causative agents, and risk factors affecting human otomycosis infections.

BACKGROUND/AIM: Otomycosis, or fungal otitis externa, has typically been described as fungal infection of the external auditory canal, with infrequent complications involving the middle ear. This study assessed a mycological analysis of fungal debris from externalauditory canals of patients at Tanta University Hospital, Gharbia Governorate, Egypt. MATERIALS AND METHODS: The samples were collected over a year from the 110 patients that were clinically diagnosed to have otomycosis. The samples were then inoculated and culture plates were examined for the presence of fungal growth. RESULTS: The results showed that Aspergillus niger was the most common fungus causing otomycosis. It was more common among males aged 21-40 years. The incidence was higher in the summer and spring seasons. Manual workers and students had the highest frequency based on occupational incidence. The most common presenting complaint was itching. Trauma to the external auditory canal was the most common predisposing factor. CONCLUSION: The epidemiological profile of otomycosis infection varied according to different factors in the study population.