Etiology of otomycosis; observations on attempts to induce otomycosis in rabbits.
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Topical antibiotic induced otomycosis.
UNLABELLED: Prior to 1999, the diagnosis of otomycosis as a cause of persistent otorrhea was rare. An increase incidence has been seen in among our outpatient pediatric otolaryngology practice. The purpose of this study is to assess the contribution of ototopical antibiotic drops to the development of otomycosis. DESIGN: Retrospective study. SETTING: Pediatric otolaryngology outpatient center. METHODS: Chart review of all patients diagnosed with otomycosis between June 1999 and September 2001. Twenty-six patients (ages 17 months-29 years) were diagnosed with otomycosis based on clinical and microbiological findings after treatment with topical ofloxacin antibiotic drops. All patients had used ototopical antibiotics, including ofloxacin in every case, for presumed bacterial otorrhea. Once the fungal source was recognized, therapy succeeded in each case (26/26). Physicians need an elevated suspicion of otomycosis as a cause of persistent otorrhea, especially following treatment with topical antibiotic drops. Appropriate treatment of otomycosis eliminates otorrhea. Ofloxacin remains an excellent choice for bacterial otorrhea, but it appears to increase the incidence of otomycosis. Thus, its usage warrants careful post-treatment follow-up.
Administration, Topical↗
Concomitant otomycosis and dermatomycoses: a clinical and microbiological study.
Otomycosis tends to recur despite long-term treatment. To our knowledge, there is no study in the English literature concerning the clinical importance of concomitant otomycosis and dermatomycoses. We investigated the presence of dermatomycoses in 52 patients with otomycosis in order to document the clinical and microbiological importance of their coexistence. Dermatomycoses on the feet and/or hands were identified in 19 patients (36.5%). The most common pathogen for otomycosis was Aspergillus niger, while it was Candida albicans for the dermatomycoses. The same pathogenic fungi were isolated from the otomycosis and dermatomycoses in nine of the 19 patients (47.4%). Aspergillus niger was the most common shared pathogen. The pathogens isolated in concomitant dermatomycoses were common pathogens for the fungal infection of the ear ( Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus, Candida albicans). It was concluded that the autoinoculation of the ear canal by pathogenic fungi might be possible in the presence of the untreated dermatomycoses. Dermatomycoses must be investigated in patients with otomycosis and must be treated simultaneously in order to prevent the recurrence of both.
Administration, Topical↗
[Prevalence and risk factors for otomycosis treated in the hospital setting in Abidjan (Ivory Coast)].
Otomycosis is frequently encountered in tropical and subtropical zones. In Ivory Coast diagnosis of this disease is often based solely on the clinical symptoms. The objectives of this study were to determine the prevalence, predisposing factors, and etiologic agents associated with otomycosis at the Treichville University Hospital Center in Abidjan, Ivory Coast. Mycological examinations were performed on specimens obtained from 115 patients presenting with external otitis at the d'Oto-Rhino-Laryngology Department. Fungi-positive cultures were obtained in 49 patients for an overall otomycosis prevalence of 42.6 (95% Confidence Interval (CI), 34.4-52.2). Univariate analysis showed that the predisposing factors for otomycosis were frequent swimming in natural or artificial pools (Relative Risk (RR) 3.7; CI 1.7-8.1), daily ear cleaning (RR 3.5; CI 1.8-6.8) and excessive use of eardrops containing antibiotics and corticoids (RR = 9.3; IC95% = 4.3-20.1). The most common etiologic agents were Aspergillus flavus (20.4%), Candida albicans (16.3%), Candida parapsilosis (14.3%), and Aspergillus niger (12.2%). A combination of two agents was found in five cases. These data show that otomycosis is endemic in Ivory Coast. Management of otomycosis must include mycological examination for diagnosis as well as changing behavior patterns leading to infection.
Adolescent↗
Otomycosis: clinical features and treatment implications.
OBJECTIVES: To determine the clinical presentation, predisposing factors, complications, and treatment outcomes of otomycosis. STUDY DESIGN AND SETTING: Retrospective review of 132 patients with a clinical diagnosis of otomycosis treated from 1998 to 2004 in an academic otology practice. RESULTS: Otalgia and otorrhea were the most common presenting complaints (48%). Prior otologic procedures increase the risk of developing otomycosis. Residual disease was observed in 13% and recurrence in 15% of the subjects. The presence of a mastoid cavity was associated with higher recurrent and residual disease rates. Topical ketoconazole, cresylate otic drops, and aluminum acetate otic drops were all relatively effective with >80% resolution rate on initial application, although topical ketoconazole had a higher resolution rate and lower rate of disease recurrence. CONCLUSIONS AND SIGNIFICANCE: Otomycosis can usually be diagnosed by clinical examination and often occurs in the setting of persistent otorrhea. Complications are not uncommon but usually resolve with application of appropriate topical antifungal agents. Eradication of disease is more difficult in the presence of a mastoid cavity.
Acetates↗
[Presumption diagnosis: otomycosis. A 451 patients study].
Otomycosis is a common disease. We try to analyze the causative factors for otomycosis in our environment. Our study includes 451 patients with a presumed diagnosis of otomycosis. The patients were included by ear, nose and throat specialist and general doctors; the diagnosis was confirmed in 24.43% and 16.16% respectively. The most common fungal pathogen found was Aspergillus spp. and Candida sp. The high frecuency of Aspergillus Niger may be because of the diferent ways of gathering samples. The abundance of Candida parapsilosis in the samples that came from general doctors may be because the inadequate treatment with topic antibiotics contributes fungal proliferation. We conclude that the causative factors for otomycosis could be avoided or treated. Treatment with antifungal agents is not enought to ensure complete cure, an furthermore the treatment should be aimed to restore the physiology of the external auditory cannal.
Adolescent↗
Otomycosis in Turkey: predisposing factors, aetiology and therapy.
Otomycosis usually requires long-term treatment and tends to recur. This study was performed on 87 patients with the clinical diagnosis of otomycosis and 20 controls in order to determine the pathogenic agents, predisposing factors and a cost-effective treatment. The predisposing factors included wearing head clothes (74.7 per cent), presence of dermatomycoses (34.5 per cent) and swimming (27.6 per cent). The most common pathogenic fungus was Aspergillus niger (44.8 per cent) in the otomycosis group. The only isolate was Candida albicans in the control group (2.5 per cent). We concluded that administration of four per cent boric acid solution in alcohol and frequent suction cleaning of the ear canal might be a cost-effective treatment for otomycosis since 77 per cent of the patients were treated effectively this way. Eighty per cent of the resistant cases had mixed fungal-bacterial infections, and 50 per cent of them had dermatomycoses. These resistant cases were treated by administration of tioconazole ointment.
Adolescent↗
Otomycosis in Nigeria: treatment with mercurochrome.
Seventy-two mycologically proven cases of otomycosis (38 males, 34 females) aged 8-80 years were investigated. Aspergillus niger was the commonest aetiological agent (43.1%) followed by Candida spp. (22.2%), A. flavus (19.4%) and A. fumigatus (15.3%). Three topical drugs, namely mercurochrome, clotrimazole and locacorten-vioform, were evaluated for otomycosis therapy in separate groups of 24 patients each. Mercurochrome was found to be the most efficacious in terms of healing, relief from symptoms of the disease and production of negative fungal cultures. Mercurochrome is recommended as a safe and economical drug for the topical treatment of otomycosis in developing countries like Nigeria.
Administration, Topical↗
Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.
Adolescent↗
[Otomycosis: presentation of 15 cases].
Fifteen cases of otomycosis in 11 women and 4 men attending the Clinic Hospital in Salamanca during the period from 1984 to 1988 are discussed. A. niger was the species isolated on the majority of occasions (73.3%). The commonest form of presentation of otomycosis was simple chronic (73.3%). The clinical pictures was characterized by serous secretion and pruritus. Otomycosis with associated bacterial infection (20.0%) was the cause of the most intense symptoms, featuring suppuration and hypoacusia. In 5 patients, local antecedents of interest were observed: three cases of chronic cholesteatomatose otitis in which surgery had been performed; retroauricular eczema, and perichondritis of the ear. Despite topical treatment with clotrimazole, 4 cases of relapse occurred (26.7%) and in none of these was associated bacterial infection observed.
Adult↗
[Analysis of 40 cases of otomycosis].
AIM: Otomycosis is a rare clinical process, with peculiar characteristics concerning its etiology and presentation, depending on the geographic area. In order to determine the most common agents, the clinical and epidemiological aspects in mycotic external otitis, 40 episodes detected during one year period were analyzed. METHODS: Forty patients with otomycosis diagnosed (positive microbiological culture) were studied. Fungi were identified in accordance with morphological and biochemical criteria. RESULTS: Candida parapsilosis (42.9%) and Aspergillus niger (35.7%) were the commonest agents. In three episodes were found associated bacterial flora. The patients were males (60.0%), between the ages of 31-40 (35.0%) and over 50 years old (37.5%). The symptoms were the usual for these processes: serous fluid, otalgia and itching. The majority of the episodes occurred in the summer (57.5%) and autumn (30.0%), due to sea bathing (90.0%), trauma (27.5%) and prior antimicrobial treatment (40.0%). CONCLUSIONS: Candida parapsilosis is as an important pathogen of otomycosis in our environment, though the participation of Aspergillus niger is also remarkable, as it happens in other geographic areas. The contact with seawater and the antimicrobial treatment are the main factors which favor the infection; climatical conditions could cooperate to it in great extent. The observed symptoms are similar to the bacterial otitis, but of lesser intensity.
Adolescent↗
[Antimycotic therapy in otomycosis with tympanic membrane perforation].
Especially after prolonged antibiotic ototopic therapy otomycosis is not rare. An inoculation of fungi into the tympanic cavity however may have serious sequelae. Therefore an eradication of fungi from the external auditory canal is imperative before surgery. In addition to thorough cleaning of the outer ear canal antimycotic preparations are recommended in treating otomycosis. However, all of the commercially available ear drops contain ototoxic agents. In the case of defects of the tympanic membrane a damage of the inner ear may result. Alternatively, we suggest an aqueous solution of Miconazol 0,5%.
Administration, Topical↗
Otomycosis: an experimental evaluation of six antimycotic agents.
One hundred-and eight-six fungi were isolated from one hundred-and-eighty cases clinically diagnosed as otomycosis. They comprise 59 species of 26 genera of moulds, and 2 genera of yeasts. This large variety of mould isolates provided ample material for in vitro experiments, to evaluate the anti-fungal activity of six antimycotic substances found in the preparations currently used for the treatment of otomycosis. The antifungal activity of clotrimazole and tolnaftate in vitro was evident. For over 94 per cent of the 59 fungus species tested, the MIC was less than 0.1 micrograms/ml, and for 6 per cent it was between 0.4 and 1 microgram/ml. Concerning the other 4 antimycotic substances (iodochlorhydroxyquin, fluonilid, natamycine and polymyxin B sulphate) the MIC ranged from greater than 100 micrograms/ml to 1 microgram/ml for the majority of tested fungi. The clinical observations were mostly in accordance with these findings.
Antifungal Agents↗
Broad spectrum antifungal agents in otomycosis.
The in vitro inhibitory activities of four currently used antimycotic agents (clotrimazole, econazole, miconazole and cyclopirox-olamine) against 304 fungal isolates comprising 51 species from 14 genera of moulds and yeasts, using a serial dilution procedure, were studied. Clotrimazole and econazole were found to have a grossly similar broad-spectrum antifungal activity, inhibiting all the tested yeasts and moulds at a concentration ranging from 0.1-4 micrograms/ml. At this range miconazole inhibited 90 per cent of the strains and cyclopirox-olamine inhibited 57 per cent only and thus they were less effective. Econazole 1 per cent solution was very effective in vivo in the treatment of otomycosis within 1-3 weeks. The drug was well tolerated, with no side-effects. Owing to the high broad-spectrum antifungal activity of clotrimazole and econazole, they should be the treatment of choice in otomycosis and can be used safely as otic drops.
Antifungal Agents↗
Mycotic infection of the ear (otomycosis): a prospective study.
Otomycosis (fungal infection of the ear) is not uncommon clinical problem encountered in our ENT practice. It makes up to 6 per cent of all patients with symptoms of ear disease seen in the Outpatient Clinic. Of the 193 patients with a clinical diagnosis of otomycosis, 171 cases produced positive fungal isolates. In this study Aspergillus species (niger and fumigatus) have been the most common fungal pathogens. Various aetiopathological factors have been examined in detail, and the available literature reviewed. The results of the treatment by nine antifungal agents currently available in Bahrain have been analysed.
Adolescent↗
Drug therapy in otomycosis: an in vitro study.
Otomycosis represents a small percentage of clinical external otitis. This well documented entity is often a stubborn clinical problem and, in contrast to bacterial external otitis, there is no otic preparation with specific antifungal activity. In response to this lack of otic preparations, we have surveyed in vitro a variety of available preparations to determine the general spectrum of activity against appropriate bacterial and fungal species. An agar-disc diffusion system was used testing the drugs against (1.) bacteria common in external otitis, and (2.) a variety of yeast and filamentous fungi. Aqueous Merthiolate and Cresylate demonstrated good non-specific antimicrobial activity, while nystatin and clotrimazole demonstrated specific antifungal activity. Otic preparations can now be used which have demonstrated in vitro effectiveness and give an alternate means of therapy to the now empirically selected otic preparation used for otomycosis.
Antifungal Agents↗
In vitro effectiveness of 13 agents in otomycosis and review of the literature.
Many agents have been recommended for treating otomycosis, but no preparation has been widely accepted. To compare the effectiveness of many recommended preparations, we performed an in vitro study using 15 species of fungi and yeast cultured from patients presenting with otomycosis during the past year. By measuring zones of inhibition, we assessed the effectiveness of aqueous Merthiolate, Burow's solution (2%), VoSol HC, VoSol plain, Cortisporin suspension, clotrimazole 1%, Mycostatin, amphotericin B, ethanol 95%, miconazole, tolnaftate 1%, natamycin, and flucytosine. Most otic preparations showed little or no growth inhibition. However, Merthiolate was very effective against all organisms tested, clotrimazole was very effective against most yeast and fungi tested, and nystatin had the widest spectrum of activity among the antifungals. Tolnaftate was ineffective. Vigorous cleaning of the external auditory canal remains the mainstay in treating otymycosis, but proper laboratory identification and suitable topical therapy are also important in dealing with this capricious infection.
Antifungal Agents↗
Otomycosis in São Paulo.
In view of the lack of researches on otomycosis in Brazil, we have tried to study their incidence, their clinical characteristics and the predispondent factors. During one year, 22 suspected cases were seen, 20 of them corresponded to otomycosis infections. The most frequent species were Aspergillus niger (35%) and Candida albicans (20%). The genus Aspergillus represented 75% of the isolates. Itching and hyperaemia (70%), otalgia (65%), hipoacusia (50%) were the commonest signs. Lack of cerumen (70%) chronic otitis (30%) previous antibiotic therapy and eczema (25%) were the most outstanding predispondent factors.
Adolescent↗