Otomycosis
Case Report
Dr. Ima Dewi R
I. IDENTITY
• Name : Mr. S
• Age : 28 years old
• Sex : Male
• Address : Pajangan, Bantul
• Occupation : Teacher
• MR Number : 1-07-52-75
II. ANAMNESIS
Chief complaint : Itching on the right ear
History of present illness :
Since a week ago, he felt itching on the right
ear. Itching presented continouesly and
disturbing his activity. To reduce the itching
he used cotton bud to manipulate the right ear,
but the itching is not reduce until he come to
the ENT Department in Sardjito Hospital.
There is no earache, no othorea, no swelling
ear and no fullness. Three months ago, he
suffer earache on the right ear and then he
went to the community health center and got
ear drop. He used the ear drop every had ear
problem. He doesn’t know the contain and the
brand name of his ear drop. He denied
coughing, sneezing and cold. There was no
complaint about fever, headache, nose and
throat disorder.
Previous history of the illness :
DM (-)
Alergi (-)
Similar disease (+) last year
Family history of the illness :
He denied the same illness in his family
Resume Anamnesis
• Itching (+)
• Manipulated ear canal (+)
• Use ear drop for a long time (+)
III. PHYSICAL EXAMINATION
General status
General condition : good
Conciousness : compos mentis
Nutrient condition : good
Vital sign
Blood Pressure : 120/80 mmHg
Pulse : 84 x / minute
Respiration : 24 x / minute
Temperature : 37 oC
Local status : see on OHP
KOH Examination hypha (+)
IV. DIAGNOSIS
Otomycosis on the right ear
V. TREATMENT
Clean of debris
Clotrimazole solution : twice daily
Education
VI. PROBLEM
Recurrency
VII. PLANNING
Control to evaluation therapy , Culture of
debris
THANK YOU
Definition
• Otomycosis is a fungal infection of the skin
of the external canal. (Bailey).
• Otitis externa due to fungal infection may
resemble the desquamative form or diffuse
infective otitis externa and is associated
with the presence of fungi (Gray)
Etiology
• The fungi most commonly found are
Aspergilus and Candida.
• Aspergilus is filamentous fungus, exhibiting
hypae which branch and intertwine to form a
dense mat of growth, the mycelium. Produced
from the mycelium are sporulating hypae or
conidiophores bearing the reproductive bodies
or spores
Etiology
• Candida is yeast-like fungus growing both as a
unicellular fungus, reproducing by budding,
and as a filamentous fungus under the same
environmental condition.
• Gugnani et al, 1989, Cause of otomycosis are
Aspergilus niger (41,9%), Aspergilus flavus
(19,3%), Candida Albican (19,3%) and
Candida Parapsilosis (12,9%)
Presdiposing factors
(Syarifudin 1983)
• Fisiologis
Pregnancy : estrogen&progesteron on the
increase much of sweatmoisture of
ear canal
• Patologis
DM, leukemia, cancer, antibiotic and
corticosteroid drug for long time.
Patophysiology
• Spora & hyfa on the airenter to ear
canalfungal growth ( Mugliston & O'
Donoghue, 1985 )
• All fungi have three basic growth
requirement : moisture, warmth, darkness.
Altering moisture will discourage fungal
growth (Bailey)
Diagnosis
A. Clinical feature
B. Physical examination
C. Laboratorium examination
Diagnosis
A. Clinical Feature :
• Itching is the most prominent symptom
• a sense of fullness
• deafness with accumulation of debris
• become more painful as tissues because
inflamed (Scott Brown’s)
Kombila et al,1989 :
• Itching (70%),
• Earache, Hypoacusia&Tinitus (30%)
Diagnosis
B. Physical Examination (Otoskopi) :
• Inflamation sign on ear canal
(hyperemiaulcerationtighten)
• Debris (white/gray/dirty yellow/black or wet
blotting paper filling) may be seen the meatus.
Diagnosis
Debris :
•Candida : soft, dirty white, resembling wet
blotting paper, sometime like cheese
Aspergillus niger : conidiophores may be seen as
black specks or fine filaments
from the meatal wall
(Scott Brown’s)
Diagnosis
C. Laboratorium Examination :
- Microscopical examination of the debris
: Debris swab on the object glass dropped KOH 10-
30%closed with glasswas warmedsee under
microscope.
mycosis will be seen hyphae which branch and
intertwine, sometime spora.
- Culture
: to know type of mycosis, using
Saboraud‘s dextrose medium
Treatment
1. Removal of mass (aural toilet)
cleansing of accumulated debris and
discharge from the meatus
2. Keratolytic agent
painted the canal with 2% salicylic acid in
alcohol for 2 or 3 days
3. Specific antifungal agent
4. Avoid predisposing factors
Specific antifungal agent
• Nystatin effective againts candida species
• Clotrimozole cream or solution (Lotrimin)
highly effective as an antifungicide
• Metacresyl acetate (cresylate) best done
under the microscope but quite irritating
• Gentian violet well tolerated in patients
with mastoid cavities
• Chloromycitin-sulfanilamide-fungizone
powder (amphotericin B) or tolnaftate powder
has a similar range of activity to nystatin
Differential Diagnosis
OEF OED Otomycosis
• Otalgia (+) • Otalgia + fullness • Itching
• 1/3 extra canal • All extra canal • Skin of the extra canal
• Furuncel (+) • Oedema (+) • Debris (+)
• Swelling with • Ear canal tighten • Fine filament/black
punctum and hyperemia speck
in hair folikel
• Oedema peri & • (+) • (-)
post auricula
• Tympanic • Hyperemia • Normal
membrane normal
