Infection Of External Auditory Canal Research Articles

A study on mycology spectrum with aetiopathological factors and its management in otomycosis

Background: Otomycosis (fungal otitis externa), is a fungal infection of external auditory canal (EAC). It is a common challenging problem in the ENT clinic, because for the need for long term treatment and follow up. The present study was thus designed with the view to know the mycological pattern encountered in otomycosis along with the aetio-pathological factors and its management. Methodology: A prospective study was done in the Department of ENT, Sri Siddhartha Medical College & Hospital, Tumkur for a period of 12 months, total of 51 patients of both genders with clinical features of otomycosis were enrolled in the study. 2 swabs were taken from the EAC of all cases and after aural toileting under microscope, were treated with 1%clotrimazole and followed up for 2 months Results: A total of 51 patients were examined in this study, of which 47 cases produced positive fungal isolates (92.1%). Females were more commonly affected than males. Most common pre-disposing factor was manipulation of the ear by unsterile material for cleaning the ear. Itching and pain were the most common symptoms, Aspergillus was the most common fungus isolated. Clotrimazole showed good response symptomatically and mycological clearance was seen within a week. Conclusion: Otomycosis is still a common problem and is often misdiagnosed for other chronic otitic conditions. Fungi thrive on exfoliated dead epithelial cells along with humid environment in EAC. Thorough cleaning of fungi followed by topical antifungal agent is important in management of this condition. Clotrimazole is effective, safe and well tolerated topical antifungal agent.

Single Topical Application of 1% Clotrimazole Cream in Otomycosis.

The online version contains supplementary material available at 10.1007/s12070-022-03206-x.

Conventional Practice of use of Cotton Bud in External Auditory Canal and it’s Complications

Objectives: To find out the complications arise from use of cotton bud in external auditory canal.
 Methods: This cross sectional study was carried out from January 2020- December 2020 in Pabna medical college hospital. About 100 patients with complications of cotton bud use were included in this study. Diagnosis was based on the history and otoscopic examination.
 Results: In this study most of the cases were age group 0-10 years -30%, 10-50-years 30%, 50-60- years 10%, more than 60 years 40%. Common Complications were Infection of external auditory canal 50%, injury to external auditory canal 40% and injury to tympanic membrane 10%.
 Conclusion: Injudicious use of Cotton bud has injurious effect for external auditory canal and should be avoided.
 Bangladesh J Otorhinolaryngol 2022; 28(1): 91-95

Comparing the Therapy of Otomycosis Using Clotrimazole with Iodine Tincture: A Clinical Trial.

Introduction:Otomycosis, as a common superficial fungal infection, is the term to infection of external auditory canal. Despite numerous studies on diverse antifungal agents, there is no common consent on effective agent for treatment of otomycosis. Therefore, the purpose of this study is compared therapy of otomycosis using two therapeutic agents; clotrimazole and iodine tincture.Materials and Methods:This research is a clinical trial study included 160 patients who were presented otomycosis. All patients were randomly assigned into two therapeutic groups of clotrimazole and Iodine Tincture (80 cases in each group). The results of response to thrapy were evaluated on 4, 10, and 20 days. Statistical analyses were performed using Independent-Samples t-test, Chi-Square, and Fishers҆ Exact tests in SPSS software v.18, in 0.05 significant level.Results:Fungal species were isolated including Aspergillus (72.5%) and Candida albicans (22.5%). After 4thday of treatment, 7.5% of the tincture group and 11.2% of the clotrimazole group revealed a good response to treatment (P=0.30). A good response to treatment was observed in35.0 and 41.2% of the patients on 10th day of treatment (P=0.44); and in 67.5 and 62.5% of the patients on 20th day of treatment (P= 0.20). There was no significant relationship between the two therapeutic arms.Conclusion:In this study, both clotrimazole and tincture showed the identical therapeutic efficacy on otomycosis. Our findings suggested that tincture can be used as a supplementary antifungal option for treatment of otomycosis.

A SINGLE CASE STUDY ON EFFECT OF LAKSHADI CHOORNA KARNADOOPANA IN OTOMYCOSIS ASSOCIATED WITH OTITIS MEDIA

Otomycosis is a common condition encountered in a general otolaryngology clinic setting and has typically been described as fungal infection of the external auditory canal with frequent complications involving the middle ear. Although rarely life threatening, the disease is a challenging and frustrating entity for both pa-tients and otolaryngologists as it frequently requires long-term treatment and follow-up. Despite this, there could be recurrences. Karnasrava is a disease mentioned by Acharya Sushruta in the chapter of Karnaroga Vigyaniya under twenty-eight Karnarogas. Karnasrava is the condition characterized by discharge from Karna and occurs mainly due to Avarana of Vata Dosha. Otomycosis being one of the causes of Karnasrava was selected for the study. Treatment of Karnasrava is explained by Sushruta i.e. Karnadoopana, Karnapoorana, Prakshaalana etc. Case Study: This is a case report of 50-year-old female patient who had complains of pain in right ear since 1 month associated with watery discharge from right ear. The subject is a known case of diabetic mellitus since 1year. The Otoscopic examination of bilateral ear, confirmed that, diagnosis of right ear was Otomycosis associated with otitis media. Materials and Method: The subject who approached Shalakya tantra OPD of GAMC with symptoms of right ear pain associated with on and off watery discharge was systematically reviewed. Intervention was planned for Doshic component involved in Karnasrava. Result: The subject showed considerable improvement in right ear. Discussion: Karnasrava is the condition characterized by Srava from Karna and occurs mainly due to Av-arana of Vata Dosha. Otomycosis is a fungal infection of external auditory canal and one of the causes for Karnasrava. This study sheds light on holistic treatment like Karnadoopana told in the Ayurvedic clas-sics.

Otomycosis and its Predisposing Factors in Out-Patient Department of Otorhinolaryngology in a Tertiary Care Center

Introduction: Otomycosis is a fungal infection of external auditory canal frequently encountered by otorhinolaryngologists. It causes discomfort to patients with varied symptoms of pruritus, otorrhea, aural fullness and earache. People with a habit of using unnecessary ear drops, cleaning ear with unsterilized objects and those who use mustard oil are all prone to otomycosis. This study aims to find out the association between otomycosis and its predisposing factors. Methods: This study was undertaken in the Department of Otorhinolaryngology of a tertiary hospital from March 2018 to February 2019 and a total of 300 clinically diagnosed cases of otomycosis were enrolled for the study. Results: The mean age ±SD of the patients was 37.7 ± 18.8 years. Females (n=172, 57.3%) were more prone to otomycosis than males (n=128, 42.7%). The most common presenting symptom was pruritus only (n=95, 31.7%) with unilateral involvement being more common. The most common predisposing factor was mustard oil instillation (n=124, 41.3%). Aspergillus niger  was the most common fungus causing otomycosis in this study (n=104, 34.7%). Positive fungal cultures were observed in 285 specimens (95%). The fungal growth (n=285) was high in patients with the history of instilling mustard oil (42.8%) into the ear, 34.0% in topical steroid containing ear drops and 23.2% in self-cleaning group. Conclusion: Otomycosis is common in people using unnecessary steroid containing ear drops, cleaning ear with unsterilized objects and instillation of mustard oil.

Efficacy of 10% Ichthammol Glycerine Pack and Steroid-antibiotic Pack for Relieving Pain in Acute Otitis Externa. A Comparative Study.

Introduction: Otitis externa is a common painful condition presents with generalized infection of external auditory canal, typically reveals erythema and edema of the skin. Aural packing plays an important role in relieving the pain and edema. For packing, either we impregnated with 10% Ichthammol glycerine or steroid-antibiotic ointment.
 Objective: To compare the efficacy of 10% Ichthammol Glycerine pack with steroid-antibiotic ointment pack for relieving the pain in acute otitis externa.
 Methodology: A prospective, non-randomized clinical trial was carried out in 94 patients at Birat Medical College and Teaching Hospital, Biratnagar, Nepal from February 2018 to July 2018. Patients diagnosed with acute otitis externa were included in this study, where 47 patients were treated with 10% IG pack and remaining 47 patients treated with a combination steroid antibiotic ointment pack. Before aural packing was carried out, pain was assessed using visual analogue scale (VAS). Both groups of patients were evaluated after 48 hours for assessment of pain.
 Results: The total number of patients included in this study was 94. Among them 41 (43.6%) were male and 53(56.4%) were female where male and female ratio was 1:1.29. Majority of the patients were below 40 years (83%). Treatment with steroid-antibiotic ointment pack had significant reduction in pain after 48 hours post treatment, none of them had severe pain, 4(8.5%) had moderate pain remaining and 43(91.4%) had only mild pain. Whereas in patients treated with 10% IG pack 1(2.1%) had severe pain, 14(29.7%) had moderate pain and 32(68%) had mild pain. There was statistically significant decrease in pain with steroid-antibiotic pack.
 Conclusions: Both treatment modalities are effective but this study showed steroid-antibiotic ointment pack, the combined therapy is more effective than 10% IG pack for relieving the pain in acute otitis externa.

Otomycosis in a Rural Community Attending a Tertiary Care Hospital: Assessment of Risk Factors and Identification of Fungal and Bacterial Agents.

Otomycosis is one of the frequently encountered fungal infections of external auditory canal, commonly seen in tropical and subtropical regions of the world. Various host (local, systemic) and environmental factors can predispose a person to otomycosis. Although clinical presentations along with otoscopic findings of the patients are well suggestive of fungal infection, proper identification of causative agents is mandatory in order to prevent recurrences and complications. To define the aetiology of clinically diagnosed otomycosis in rural population, to derive association of risk factors with otomycosis, to isolate and identify fungal and bacterial agents and to analyze the association between them. A prospective study was conducted in the Department of Microbiology and Department of Ear, Nose and Throat (ENT), SGT hospital over eight months period. A total of 350 consecutive patients of more than five years of age with clinical diagnosis of otomycosis were included in the study. Demographic profile, predisposing factors, presenting complaints and clinical findings of clinically diagnosed patients were evaluated and analyzed. Samples were collected, transported and evaluated by both direct examination and culture method for bacteriological and mycological examination. Male to female ratio in study participants was 1.3:1. Mycological examination yielded 346 fungal isolates in 310 samples from a total of 350 clinically diagnosed cases of otomycosis. Self cleaning, instillation of mustard oil and use of ear drops appeared to be common predisposing factors in otomycosis. Significant association was observed between these practices and otomycosis. Aspergillus species was the predominant fungi followed by Candida spp., Penicillium, Mucor and Trichophyton mentagrophyte. 11% of the cases were found to have mixed fungal and bacterial infections. The present study highlights the highest isolation of Aspergillus complex in cases of clinically diagnosed otomycosis in a rural community with higher practice of self cleaning and using home remedies and eardrops to get relief from sensation of blocked ear and itching.

Efficacy of fluconazole powder in treatment of fungal infection of external auditory canal

One hundred and forty patients(165 ears)with fungal infection of external auditory canal were treated in Department of Otolaryngology, Tianjin Fourth Hospital from October 2012 to October 2014. Patients were randomly assigned in two groups: 70 cases (83 ears) received local administration of fluconazole powder (study group) and 70 cases (82 ears) were given local miconazole cream. After 3 weeks of treatment the overall effective rates in study group and control group were 95.18% (79/83) and 73.17% (60/82), respectively (χ2=15.05, P<0.05). Patients were followed up for 6 months the recurrence rates in study and control groups were 6.32% (5/79) and 28.21% (22/78), respectively (χ2=13.19, P<0.05). Results indicate that local administration of fluconazole powder is effective in treatment of fungal infection of external auditory canal with safety and low recurrence rate. Key words: Fluconazole; Ear canal; Fungi; Infection

A Case of Central Skull Base Osteomyelitis Concurrent with Multiple Lower Cranial Nerve Palsies

In most cases, skull base osteomyelitis arises from infections of external auditory canal, middle ear or paranasal sinuses. On the other hand, atypical or central skull base osteomyelitis has no evidence of external otitis or other infection sources. It is often found located on clivus and involves lower cranial nerves and brainstem through the foramina of skull base. The overall rate of mortality reaches 10% and long-term neurologic sequelae are seen in additional 31% of cases regardless of aggressive treatment. We recently encountered a 68-year-old man with right facial pain and generalized headache, and we achieved good outcome with the recovery of vocal cord palsy and disappearance of headache by surgical debridement and long-term antibiotics. We report it with a review of literature.

English

Otomycosis is a fungal infection of External auditory canal. Otomycosis has worldwide distribution with high prevalence in hot, humid and dusty climates of tropical and subtropical regions. Management of Otomycosis is dependent on thorough understanding of anatomy of external ear canal, knowledge of microbiology and pathophysiology of potential pathogens. OBJECTIVES: To determine importance of various aetio-pathological factors in causation of Otomycosis. To study pattern of fungal isolates encountered in cases of Otomycosis. To study management of the disease. MATERIALS AND METHODS: This study was undertaken in the Department of Otorhinolaryngology, Sri Siddhartha Medical College & Hospital, Tumkur from January 2012 to December 2012. It was a time bound study, wherein 51 cases were studied. OBSERVATION AND RESULTS: Highest incidence (25.5%) was noted in age group of 21-30 years. Common predisposing factor was use of unsterile material for cleaning ear in 55.3% cases. Fungal debris within canal in form of wet brownish black or grey mouldy mats/ spores with epithelial debris was found in 53.2% cases. Aspergillus was most common fungus isolated in 81%. Clotrimazole showed good response symptomatically and mycological clearance was seen within one week in 74.4% cases and persistence of disease up to 2 - 4 weeks was seen in 25.5% cases. On follow up failure or recurrence disease within 2 months was observed in 10.6% of cases. CONCLUSION: In conclusion Otomycosis/mycotic otitis externa is still a common problem and is often misdiagnosed for other chronic otitis conditions.

Necrotizing (malignant) otitis externa: An unusual localization of mucormycosis

Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy.