Fungus in the ears: treatment, symptoms, causesotomycosis

Update: December 2018

Otomycosis refers to inflammation of various parts of the ear caused by
грибковой infection. The auricle and external can be amazed
auditory canal, eardrum, and postoperative
the area during surgery on the middle ear.

Pathogens and conditions of occurrence

Mushrooms that cause the development of otomycosis are divided into true (or
obligate parasites and opportunistic microorganisms,
приобретающие свойство вызывать инфекционный process только при
certain circumstances.

  • True parasitic fungi (for example, ascomycetes) exist.
    due to living tissue (human, animal or plant). If a
    infection occurs, the disease necessarily develops with
    bright clinical symptoms.
  • Conditionally pathogenic fungi (most common
    yeast-like and moldy) normally live on the surface of the skin and
    mucous membranes may coexist with normal bacterial
    flora. The development of the disease is possible only if the violation of natural
    human body defenses (local barriers and general system
    immunity). Representatives of the fungus Candida albicans and Aspergillus
    fumigatus can cause in people with severely weakened immunity
    only otomycosis, but also be the cause of septic
    complications.

Наибольшее значение для возникновения otomycosis имеют:

  • Mold Aspergillus and Penicillum
  • yeast-like fungi of the genus Candida.
  • the disease can cause fungi of the genera Mucor, Alternaria,
    Kladosporium.

Самая частая причина появления otomycosis – поражение грибами
genus Aspergillus. These microorganisms are widely distributed in
bred in decaying organic debris, spoiled
food, household dust, as well as in the soil. In the nasal cavity and mouth fall
with air, food or water. In the presence of chronic lesions
infections when there is stagnation on the surface of the mucous membranes
secretions, fungi can linger and accumulate in the oropharynx and
nasopharynx. В полость middle ear они попадают из глотки через
Eustachian tube.

In more than half of the cases, the fungal infection is combined with
bacterial disease or viral-bacterial
associations.

Factors contributing to the development of the disease

There are a number of internal and external factors, the impact of which
dramatically increases the likelihood of developing a fungal infection of the ears.

Наиболее значимые причины появления otomycosis:

  • immunodeficiencies: resulting from HIV infection and AIDS,
    malignant neoplasms, treatment with drugs that oppress
    immunity (immunosuppressants, cytostatics), prolonged
    antibiotics and corticosteroids, after transplantation
    organs and tissues;
  • environmental factors (exposure to low doses of radiation,
    contact with chemical agents, long stay in wet
    premises);
  • diet with a lack of vitamins, proteins;
  • diseases of the digestive tract (in violation of the composition and
    amounts of intestinal flora);
  • allergic reactions and diseases;
  • diabetes.

Also contributes to the defeat of fungi mechanical trauma,
especially when wearing a hearing aid or when
ear hygiene.

Classification

For the duration of ear otomycosis can be:

  • acute (lasts no more than 1 month),
  • subacute (from 1 month to six months)
  • chronic (more than 6 months).

Chronic forms proceed, as a rule, without the general
intoxication syndrome and with periodic appearance of the most
characteristic local signs: pain in the affected ear,
changes in the skin and pathological secretions from the auditory
passage.

Depending on the location of the lesion, they share the fungal:

  • otitis externa;
  • inflammation of the eardrum (myringitis);
  • otitis media;
  • отит послеоперационной полости middle ear или средний
    postoperative otitis.

External otomycoses

External fungal otitis, as a rule, are primary,
that is, occur in the absence of a previous disease
(for example, chronic bacterial focus of infection).

Clinical manifestations of external mycotic otitis media:

  • discharge from the ear canal (of various types, depending on
    specific fungus pathogen);
  • aching or dull pain in the ear;
  • feeling of constant itching;
  • congestion in the ear;
  • hearing loss;
  • increased sensitivity of the ear canal and ear
    shells;
  • formation of traffic jams and crusts.

Along with the local develop and common manifestations of infectious
воспалительного processа: головные боли, ломота в теле и повышение
temperature

Ear aspergillosis

Aspergillus fungi are characterized by a decrease in
lumen of the auditory canal due to severe infiltration of the skin
its bony part (segment of the auditory canal, located inside
temporal bone). Abundant pathological secretions have gray,
gray-black or greenish color.

The hallmark of this fungal infection is
plaque on the walls of the ear canal, which is difficult
removal, and when it is separated from the affected skin remains
bleeding surface. With aspergillus inflammation of the ear process
extends to the eardrum. Myringitis develops,
which is manifested by its thickening due to infiltration
the causative agent.

see Symptoms and treatment of aspergillosis.

Yeast Fungi

When otomycosis caused by yeast-like fungi, the selection
have yellow color, they look like abundant earwax. Characteristic
the presence of watery plaque on the entire surface of the skin of the ear, as well
dry crusts, films.

When joining myringitis is observed:

  • redness of the tympanic membrane;
  • the formation of surface wounds (erosion);
  • puffiness that creates an impression
    perforation.

Breaks eardrum is not typical.

Candidal external otitis characterized by a slight
decrease in the lumen of the ear canal, most pronounced in
the area of ​​the cartilaginous part. With myringitis, the eardrum is swollen,
of red color. Characterized by eczema-like (with rashes in the form of
bubbles with transparent or purulent contents, tight nodules)
skin changes of the ear canal and inflammation of cartilage,
the outcome of which may be gross deformation of the auricle.

Also the symptoms of a fungus in the ears are thin patches of whitish or
gray, spread over the entire skin of the auditory
passageway and easily removable. Appear liquid or
cheesy nature of the discharge, dry
crusts (most often located in the cartilaginous part). With this type
otomycosis is very pronounced sensitivity as well as pain
ear canal and auricle. With the defeat of the drum
membranes it has a dull color, its contours are smoothed.

Isolated myringitis practically does not occur.

Features of mycosis of the middle ear

  • Most often in adults, the middle ear is affected by fungi.
    Aspergillus (about 2/3 cases of diseases)
  • Candida lesion in about 20%
  • The frequency of lesions with yeast-like fungi is less than 5
    %
  • In a child, the most common cause of otomycosis is
    are yeast-like mushrooms.

In most cases, fungal otitis media are
secondary and occur as a result of fungal
infection against the background of chronic, long-term bacterial
otitis media, which changes the clinical picture of the disease.

Symptoms of chronic otomycosis:

  • persistent or intermittent suppuration;
  • inflammatory changes in the skin of the ear (swelling, redness, itching,
    discharge and plaque);
  • sensation of fluid in the ears and congestion;
  • hearing loss.

Patients have a constant headache, as well as
there is an increase in lymph nodes located close to the ear with
the development of lymphadenitis. In the long run, complications in
not only damage to the mucous membrane of the middle ear, but also
development of osteomyelitis involving the periosteum.

One of the diagnostic criteria is the development of
resistance to ongoing about the previous bacterial
Otitis media antibiotic therapy.

Average postoperative otitis

If during surgery on the middle ear occurred
ingress of fungal flora in the area of ​​the wound (due to
cuts of skin and mucous membranes), then in the postoperative
периоде  также возможно развитие otomycosis.

This is facilitated by the weakening of the protective barriers against
the body’s stress response to surgery, as well as inflammatory
process в области оперативного вмешательства. Constant
temperature, humidity and access of air activates reproduction
fungal flora and contributes to the development of specific fungal
inflammation.

Clinical signs of fungus:

  • резко замедленный process заживления и восстановления
    epidermis (epithelial lining of the middle ear);
  • the formation of a significant amount of granulation (granular)
    fabrics;
  • a large amount of abnormal discharge;
  • dark blooms and crusts on the postoperative walls
    cavities.

Ear fungus complicates and prolongs the postoperative period and
requires specific treatment.

Treatment approaches

How to cure a fungus in the ear completely, without renewing
processа и возврата симптоматики? In modern clinical
practice uses a differentiated approach to the choice of therapy,
based on mycogram data. It consists in sowing material
(smear or discharge), identification of the pathogen and its analysis
drug sensitivity.

The basic principles of treatment:

  • systemic and local antifungal therapy;
  • restoration of the normal functioning of the system
    immunity;
  • normalization of intestinal microflora;
  • cancellation of antibacterial agents (in the absence of bacterial
    inflammations);
  • in the presence of allergic reactions – desensitizing
    therapy.

For the treatment of fungus in the ears, mainly local
anti-fungal therapy. Systematically (in the form of injections, tablets)
drugs prescribed for recurrent relapses of the disease. Doses and
the timing of administration depends on the prevalence of the lesion, and not on
primary localization. Given the greater likelihood of relapse,
spend consistently several treatment courses.

 The main drugs for the treatment of otomycosis

  • Otomycosis caused by mold fungi are effectively treated
    nitrofungin and naftifine.
  • In candidal lesions, clotrimazole is most commonly used.
    natamycin, terbinafine.

Clotrimazole, Fluconazole

Antibiotics group azoles. Pros: A wide range of activity,
local and general use, low toxicity. Cons: Frequent
recurrence of candidiasis, especially mucous membranes. Ways to increase
эффективности: Определение чувствительности возбудителя к препаратам у конкретного
the patient.

Imidazoles

  • Clotrimazole (Candide 270 -300 rub, Clotrimazole from 50 to 300
    rub)
  • Ketoconazole (Nizoral cream 430 rub, Mycozoral ointment 300 rub,
    tab. 460 rubles, Ketoconazole table 250 rubles.)

Triazoles

  • Fluconazole (Fluconazole 170 руб tab. Флюкостат 200 руб,
    Микомакс 200 руб, Микосист 270 руб, Дифлюкан 800 rub)
  • Itraconazole (Irunin, Itrazol caps. 370-700 rub, Orungamin 800
    rub. Кандитрал 1000 rub.)
  • Вориконазол (Фифенд tab. 21 000 — 26 000 руб, Вориконазол 19
    000 rub.)

Amphotericin B

Antibiotics of the polyene group. Pros: The widest range
antifungal activity. Cons: Severe toxicity at
system application. Ways to increase эффективности: Применяют
locally, in the postoperative period washed postoperative
cavity, use turunda and tampons. Цена: Amphotericin B 30 rub.
1 PC.

Naftifine

Allylamine derivatives. Pros: Effective against
yeast-like fungi, reduces inflammation and itching when local
application. Cons: Cannot be used if the skin is damaged.
covers and membranes of the eardrum. Ways to increase
effectiveness: It is used in the form of applications in monotherapy in
combination with other drugs.

Price: Microderil cream 300 rub, Exoderil cream, solution 520 rub,
Мизол гель 370 rub.

Chlorinitrophenol

Pros: Antifungal agent of broad spectrum,
especially effective against yeast-like fungi. In higher
concentrations than fungicidal, active against
gram-positive and gram-negative bacteria. Cons: Possible
irritation during application and skin reaction when exposed
sun rays. Ways to increase эффективности: Применяют как в
pure and diluted with water 1: 1. Need to take care
treated skin areas (auricle) from direct sun
impact.

Цена: Нитрофунгин (300 rub), раствор для наружного
application.

Combined drugs

A separate group consists of combined drugs. They
contain components with different healing effects, which allows
increase the effectiveness of treatment.

Triderm, Akriderm

Ingredients: Clotrimazole, gentamicin in the Triderm ointment and cream
and betamethasone, with the result that they possess not only
antifungal effect as well and antibacterial. This allows
use medications for fungal-bacterial associations, and
anti-inflammatory and anti-allergic effect of the drug
helps to reduce symptoms, especially itching and pain.

Цена: Акридерм 340 руб, Тридерм 720 rub.

Travocort

Состав: мазь Travocort содержит изоконазол и дифлукортолон,
It has both antifungal and anti-inflammatory effects,
relieves pain and quickly improves well-being
the patient.

Цена: Travocort 750-950 rub.

Pimafukort

Состав: в креме и мази Pimafukort содержится неомицин,
natamycin, and hydrocortisone. They обладают выраженным антигрибковым
effect (especially in relation to yeast and yeast-like fungi),
antibacterial drug from the group of aminoglycosides new
generations determines efficiency against a wide range
bacteria that can cause bacterial otitis, and
противовоспалительное действие ускоряет processы выздоровления.

Цена: Pimafukort 500-600 rub.

Candiotics

Состав: капли Candiotics содержит клотримазол, хлорамфеникол,
beclomethasone, lignocaine and has antibacterial,
antifungal, anti-inflammatory, analgesic effect.
No toxic effect on the structure of the inner ear and
pronounced anesthesia determines the breadth of this
drug.

Цена: Candiotics ушные капли 300-350 rub.

Features of local treatment

A large number of drugs used in the drops, due to
convenience of their use. Creams and ointments are not always possible exactly
apply on the damaged surface, and narrowed during inflammation
the auditory canal makes delivery of medicinal
substances to the affected areas. In this application
alcohol-containing solutions are contraindicated in perforation
eardrum. In addition to instillation, liquid medicinal
the means are delivered to the site of injury by means of cotton wool or
tampons

Basic solutions for topical use:

  • 1% alcohol solution of fungifen;
  • 0.1% alcohol solution of quinosol;
  • sanguinarine;
  • 2% alcohol solution of flavofungin;
  • miconazole
  • Nystatin emulsion (50 000 IU in 1 g);
  • an aqueous solution of nystatin sodium salt;
  • aqueous solution of levorin sodium salt;
  • 1% grizemin emulsion;
  • 0.5% lutenurin emulsion;
  • 2% salicylic alcohol;
  • Castellani liquid.

In humans, treatment with local remedies is carried out after
preparation.

The main stages of preparation

  1. Ear pre-cleaned from pathological secretions,
    raids, crusts, earwax (performed by a doctor under the visual
    control) using a special thin probe. If the doctor is near
    No, you can gently brush the ear with cotton buds moistened
    hydrogen peroxide solution, but movements must be accurate and
    by no means “through pain”.
  2. With perforation of the eardrum and with postoperative
    otitis media removes fungal masses from the end section
    external auditory canal and the tympanic cavity is washed
    antifungal antiseptic.
  3. Apply with solutions, creams, ointments, or
    bury drops, given the contraindications to the use of specific
    drugs.

How and what to drip

The applied solution should be warm, a bottle of medicine
can warm in your hand. To drip drops in the ears, you must lie on
healthy side.

  • Sore ear need to pull up and back
  • If the child is less than 3 years old – down and back to straighten.
    auditory canal.

Drops from the fungus in the ears in the required amount buried in the ear
(usually 5 drops), click on a small overhang of the auricle
(tragus) and hold for a few seconds. Within 2-3 minutes it is important not
change poses (lying on your side) to evenly
distributed, or insert a small cotton swab into your ear. If in
The instructions are not written otherwise they are buried 3-4 times a day in the ears.

How to make a turunda

Turunda for the local treatment of otomycosis is best done from
sterile cotton wool that needs to be stretched and fluffed. Further,
starting from the central part, roll a thin (up to 2 mm) roller
about 10 cm long. This roller is folded in half and twisted –
turunda ready. It is moistened with a warm solution or ointment / cream and
twist gently into the ear. Patient position
the same as when dropping instillation. In the ear turunda should
be until the drug dries (about 3 hours).

What not to do?

  • You can not treat otomycosis with warming compresses.
  • It is also important to avoid contact with dust, gases and chemicals.
    reagents not to be at high humidity and temperature
    air,
  • Make sure that the affected areas do not fall
    water.

The choice of drug, depending on the etiology and location
otomycosis

As a result of the analysis of the characteristics of lesions of various departments
ear different representatives of the fungal flora and its sensitivity to
anti-fungal drugs developed treatment regimens.

Локализация otomycosis и вид возбудителя Drugs Mode of administration A course of treatment
Candida external otitis
  • Clotrimazole, 1% solution;
  • Naftifine, 1% раствор
Locally in the form of successive applications for 10 minutes, 2 times a
day.
28 days
External otomycosis caused by mold fungi
  • Chlorinitrophenol;
  • Naftifine, 1% раствор
Locally in the form of successive applications for 5-10 minutes 2 times
в day.
28 days
Candida otitis media and mycosis of the postoperative cavity
middle ear
Fluconazole Inside, 50-100 mg once a day 14 days
  • Chlorinitrophenol;
  • Naftifine, 1% раствор
Locally in the form of successive applications for 5-10 minutes 2 times
в day.
28 days
Средний отит и микоз послеоперационной полости middle ear,
caused by molds
Itraconazole Inside, 100 mg 1 time 14 days
Terbinafin Inside, 250 mg per day 16 days
  • Chlorinitrophenol;
  • Naftifine, 1% раствор
Locally in the form of successive applications for 5-10 minutes 2 times
в day.
28 days

Second two weeks of topical medication
carried out after the complete disappearance of clinical manifestations
fungal infection, as well as to obtain a negative analysis
from the laboratory for the presence of fungus three times.

Traditional methods of treatment

Folk treatment (medicinal plants) can complement
traditional therapy. However, before using it is necessary
проконсультироваться  с лечащим врачом. Use broths and
infusions of herbs (chamomile, bird cherry leaves, bay leaf), and
juice of onion, celandine, aloe, preparations based on propolis:

  • 5 drops of aloe 3 p / day for a week,
  • fresh onion juice buried in the ear for 5 drops at night 7
    days
  • broth celandine warm for 5 drops 2 p / day, can be in the complex
    with broth of bird cherry.

Bury herbal remedies, as well as medicines can only
with a whole eardrum. It is acceptable to wipe the skin of the outer
the auditory canal and inject medicinal substances using cotton
tampons or turund.

Профилактика otomycosis

  • Healthy lifestyle, hardening.
  • Do not use cotton swabs, sharp objects for cleaning ear
    cavities.
  • Take antibiotics and hormones only
    doctor’s appointment
  • When bathing in ponds and pools to protect the ears from getting
    water
  • Time to treat diseases of upper respiratory tract.

Thus, otomycosis is a common pathology requiring
timely recognition and adequate, durable and
thorough treatment. Modern arsenal of drugs
allows you to achieve a positive result in the fight against this
infection.

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