Management and Treatment of Otomycosis

Otomycosis is a superficial fungal infection of the external auditory canal characterised by pruritus, otalgia, otorrhoea and sometimes hearing impairment. It most commonly follows disruption of the ear’s natural defences through prolonged antibiotic use, humidity, local trauma or underlying skin disease. Effective management hinges on thorough mechanical debridement to remove fungal debris, followed by topical antifungal therapy. Agents such as imidazoles and polyenes are instilled for two to four weeks, with systemic triazoles reserved for refractory or invasive cases. Adjunctive antiseptics, including povidone-iodine, provide an alternative where resistance or tolerance arises. Patient education on ear hygiene and avoidance of excessive moisture underpins prevention. Emerging concerns include recurrence in immunocompromised hosts, biofilm formation and azole resistance, which may necessitate susceptibility testing and combination therapy. Globally, variable prevalence in tropical and subtropical regions underscores the need for context-specific guidelines and cost-effective interventions.

Research from Nature Portfolio

A comprehensive analysis of black Aspergillus isolates revealed variable in vitro resistance to medical azoles and highlighted the multifactorial basis of treatment failure. Sequencing of the cyp51A gene showed non-synonymous mutations that did not significantly alter protein structure, while homology modelling confirmed minimal conformational change. Instead, overexpression of efflux pump genes (mdr1 and mfs) emerged as a principal mechanism driving decreased susceptibility. These findings underscore the importance of broad resistance profiling beyond cyp51A mutations and suggest that monitoring efflux-related gene expression may inform antifungal selection and dosing strategies to overcome clinical resistance.

Management and Treatment of Otomycosis publication trend

The graph below shows the total number of articles in management and treatment of otomycosis across all publications each year (not limited to Nature Index journals).

Technical terms

Otomycosis: Superficial fungal infection of the external auditory canal.

Azoles: Antifungal agents that inhibit 14α-demethylase, disrupting ergosterol synthesis.

Efflux pumps: Membrane transport proteins that expel antifungal drugs, contributing to resistance.

Debridement: Mechanical removal of fungal and keratinous material from the ear canal.

Polyenes: Antifungals that bind to ergosterol, creating pores in fungal membranes.

References

1. cyp51A mutations, protein modeling, and efflux pump gene expression reveals multifactorial complexity towards understanding Aspergillus section Nigri azole resistance mechanism. Scientific Reports (2024).
2. Etiology, Predisposing Factors, Clinical Features and Diagnostic Procedure of Otomycosis: A Literature Review. Journal of Fungi (2023).
3. Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment. Brazilian Journal of Otorhinolaryngology (2017).
4. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial. Brazilian Journal of Otorhinolaryngology (2019).