Abstract
In otomycosis with tympanic membrane perforation, many physicians prefer to insert an ear wick medicated with antimycotic cream. This needs multiple visits to the clinic and keeps the ear blocked for several days. Direct instillation of alcohol based antimycotic solution causes severe burning if it reaches the middle ear. In this work we compare patient's self medication with clotrimazole antimycotic solution used on Q-tips with physician-inserted ear wicks; in terms of safety, efficacy and patient satisfaction. STUDY DESIGN #ENTITYSTARTX00026; Prospective controlled study in ambulatory setting. Forty consecutive patients with otomycosis with tympanic membrane perforation were included in the study. Diagnosis of otomycosis was both clinical and with mycological culture. Mean pure tone average (PTA) in the involved ear was measured after cleaning fungal debris. Patients were then, randomized into two groups; Q-tip group patients (n=20) were taught to self-medicate their ears two times daily with the clotrimazole solution on suitable Q-tips for three weeks. In ear wick group (n=20), a gauze wick impregnated with clotrimazole cream was inserted in the ear. Wick was changed every third day for two more visits (one week overall). Patients were followed up for 3 months. After three weeks all patients in Q-tip group and ear wick group had relief of their ear itching and complete disappearance of fungal growth in the deep meatus and on the tympanic membrane. PTA was 22 ± 11dB in Q-tip group and 25 ± 12 dB in ear wick group; the difference was not statistically significant (p= 0.11). Patients in ear wick group had sense of ear blocking and wetness during period of treatment. Transient burning sensation was reported by 2 patients in Q-tip group. During three months, there was recurrence of otomycosis in 5 patients from ear wick group and no recurrence in Q-tip group (p=0.04). Self medication with clotrimazole solution on Q-tips and physician inserted medicated wicks are equally safe in treating otomycosis with perforated tympanic membrane. However, self medication with antimycotic solution on Q-tips gives more patient satisfaction and less rate of otomycosis recurrence.
Highlights
Otomycosis is common in the ENT practice.It is the presenting problem in 6-9% of otologic patients. [1,2] There has been an increase in the prevalence of otomycosis in recent years due to the extensive use of antibiotic eardrops.[3]
Patients were randomized into two groups: Q-tip group patients (n=20) were taught to apply 1% clotrimazolesolution (Canesten®, Bayer -Germany) to the perforated ear using a Q-tip of suitable size; moderately soaked in clotrimazole solution
Two patients from Q-tip group and three patients from ear wick group were lost in the follow up
Summary
Otomycosis is common in the ENT practice.It is the presenting problem in 6-9% of otologic patients. [1,2] There has been an increase in the prevalence of otomycosis in recent years due to the extensive use of antibiotic eardrops.[3]. Otomycosis is common in the ENT practice. It is the presenting problem in 6-9% of otologic patients. Treatment of otomycosis usually requires use of antifungal drops for at least three weeks to prevent recurrence. Eradication of otomycosisis more difficult in ears with perforated tympanic membrane.[9,10] Direct instillation of antifungal solution with a dropper is associated with stinging and burning sensation. Dermatologic antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Insertion of an ear wick saturated with antifungal solution or cream may be used to increase the contact time with meatal skin and to limit the seepage of the irritant solution to the middle ear. Insertion of an ear wick saturated with antifungal solution or cream may be used to increase the contact time with meatal skin and to limit the seepage of the irritant solution to the middle ear. [11]
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