Treatments: Fungal Otitis Externa
These notes are for educational purposes only and do not constitute medical advice. See the disclaimer.
how is fungal otitis externa treated?
Fungal otitis externa, an infection of the outer ear canal caused by fungi, requires a specific treatment approach that differs from that for the more common bacterial otitis externa.
Cleansing the Ear Canal: The first step often involves careful cleaning of the ear canal by an Ear, Nose, and Throat physician or midlevel provider. This is critical step removes debris, earwax, and infected material, allowing for better penetration of topical treatments.
Topical Antifungal Medications: Application of an antifungal medication to the ear canal skin is typically undertaken. Modifications to this step may be made for patients known or suspected of having a hole in their eardrum. Several options for topical (surface) treatments exist, including the following:
Gentian Violet is a very purple colored solution with antifungal properties that a physician may place in the ear canal surfaces.
Antifungal cream, such as nystatin or clotrimazole cream may be placed deep in the ear canal by an Ear, Nose, and Throat physician. Adequately deep placement of cream is not typically achievable by oneself at home. Filling the ear canal with cream does muffle hearing for several days until the cream dissipates adequately for sound wave transmission.
Antifungal solution, such as clotrimazole 1% solution, may be performed at home by tilting the affected ear upwards, applying about 3-5 drops, and pushing on the cartilage at the front of the ear canal (tragus) for several seconds as gravity helps the drops penetrate to the eardrum. Clotrimazole 1% solution is over-the-counter but may not be readily available at most pharmacies. It is usually obtainable from an online retailer such as Amazon.
Acidic Ear Drops: In some cases, acidic ear drops may be used to restore the normal pH of the ear canal, which can dissuade fungal growth and promote healing. This option may be used after the infection is cleared to minimize the chance for recurrence.
Possible Use of Systemic Antifungal Medications: Oral or even intravenous administration of antifungal medication is usually reserved for severe or resistant cases because of the risks and side effects associated with systemic antifungal therapy. Fluconazole (Diflucan (R)) is available in pill form, but has the risk of liver toxicity, and is prescribed with caution, especially when liver disease or alcohol use is present.
Keeping the ear dry: Since fungus thrives in moist environments, keeping the ear canals dry helps fight the infection. An exception to this rule, of course, is use of medication drops recommended by your physican for the fungal infection. Keeping shower or bath water out of the ear may be facilitated with careful technique and possibly the use of ear plugs or cotton balls coated with vaseline when bathing. Additional techniques to dry the ears after water exposure include the following:
Use of a hair dryer pointed at the ears after water exposure.
When there is no perforation of the eardrum, an alcohol-vinegar solution may be applied to the ear canal. In a medicine dropper obtained from a pharmacist, a 50:50 mixture of rubbing alcohol and distilled white vinegar may be made. A few drops of this in the ear canal can help dry the area and restore a normal low pH environment. Note that this solution may cause pain in a highly inflamed ear canal, and this technique may not be practical until inflammation has subsided somewhat.
Avoiding Irritants: Foreign objects, including Q-tips (cotton buds) and bobby pins, must not be used in the ear canals as they chafe the skin and pack wax and infectious debris deeper in the ear canal.
Maximizing Immune System Function: Diabetics must maintain good blood glucose control to facilitate the ability of their immune system to fight the infection. People taking drugs that weaken the immune system should discuss possible medication adjustment with their prescribing physician.
Follow-Up: Successful resolution of fungal otitis externa usually requires multiple return visits to the Ear, Nose, and Throat office for ear cleanings. At these visits, it may become apparent that the medication strategy may require adjustment. In more severe or resistant cases, oral antifungal medications may be considered.
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