All about otomycosis

Otomycosis is caused by a fungal infection, which can be favored both by external factors and by predisposing organic conditions.

The term otomycosis indicates a fungal infection that develops in the ear canal, that is, in the canal lined with skin that from the basin of the auricle reaches the eardrum. It is therefore a form of otitis externa.

Causes

The development of fungal colonization in the external ear canal is generally related to facilitating conditions.

Among the most common risk factors are:

• the hot-humid climate, which favors the multiplication of germs
• water sports, which expose the ear canal to continuous “washing” with water containing disinfectants (in the pool) or saline (at sea), causing irritation of the skin and removing the protective coating of earwax
• inappropriate hygiene practices (e.g. incorrect use of cotton buds), which can damage the skin of the duct, remove an excessive amount of earwax or push it to the bottom
• an abnormal arrangement of the ear canal, which results in stagnation of water residues and detergents after bathing or showering
• lesions of the skin lining of the duct due to trauma or surgical outcomes
• alteration of normal microbial flora resulting from the local use of antibiotics or corticosteroids
• certain dermatological diseases (eczema, psoriasis, seborrheic dermatitis)
• immune system disorders.

The internal environment of the ear canal is represented by:

• waxy secretion, which due to its hydrophobic nature, its acidic pH and the presence of antibacterial enzymes prevents the development of pathogenic germs
• the local microbiota, consisting of the population of various so-called symbiotic microorganisms, which normally live in the ear canal in balanced proportions.

Its integrity is especially important to prevent infections of the outer ear.

The fungi responsible for most otomycosis are some species of the genus Aspergillus (Aspergillus niger and Aspergillus fumigatus) and Candida albicans. In any case, these are components of the aforementioned local microbiota, which in the presence of the predisposing conditions described can multiply abnormally.

Symptoms

Otomycosis manifests itself with the typical symptoms and signs of inflammation, that is, pain, redness, swelling, but it is above all connoted, more than other forms of infectious otitis externa, by intense itching and the presence of abundant secretion, whose characteristics depend on the type of fungus responsible for the infection.

The swelling and accumulation of secretions inside the canal, consisting of the fungal material and debris produced by the desquamation of the inflamed skin, can cause a sensation of internal compression (called “full” ear) and muffling of hearing.

Diagnosis

The diagnosis of otomycosis can be made by the doctor simply by observing the characteristics of the secretion with an instrument called an otoscope. Easily recognizable is the presence of hyphae and fungal spores in Aspergillus infections or creamy white matter in Candida infections.

Identification of the pathogen may be more difficult in cases where the proliferation of fungi is superimposed by a bacterial infection. In this case it may be necessary to swab the secretions for a microbiological examination.

Therapy

Although it can also be very annoying, under normal conditions the infection resolves with proper cleaning of the canal and with local treatment with specific products.

The correct therapy requires that there is a precise etiological diagnosis of the type of infection, and therefore it should always be prescribed by the doctor or otolaryngologist specialist.

The removal of secretions, necessary for local treatments with antifungal and possibly antibacterial compounds (in case of mixed infection) to be effective, must also be performed by the doctor.

Obviously, important both for healing and prevention of subsequent infections is the control of risk factors that may be present and the maintenance of appropriate ear hygiene.