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
- 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
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,
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
In more than half of the cases, the fungal infection is combined with
bacterial disease or viral-bacterial
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
- 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;
Also contributes to the defeat of fungi mechanical trauma,
especially when wearing a hearing aid or when
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
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
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
- 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
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.
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
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
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)
- a large amount of abnormal discharge;
- dark blooms and crusts on the postoperative walls
Ear fungus complicates and prolongs the postoperative period and
requires specific treatment.
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
The basic principles of treatment:
- systemic and local antifungal therapy;
- restoration of the normal functioning of the system
- normalization of intestinal microflora;
- cancellation of antibacterial agents (in the absence of bacterial
- in the presence of allergic reactions – desensitizing
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.
Antibiotics group azoles. Pros: A wide range of activity,
Antibiotics of the polyene group. Pros: The widest range
Allylamine derivatives. Pros: Effective against
Price: Microderil cream 300 rub, Exoderil cream, solution 520 rub,
Pros: Antifungal agent of broad spectrum,
Цена: Нитрофунгин (300 rub), раствор для наружного
A separate group consists of combined drugs. They
contain components with different healing effects, which allows
increase the effectiveness of treatment.
Ingredients: Clotrimazole, gentamicin in the Triderm ointment and cream
Цена: Акридерм 340 руб, Тридерм 720 rub.
Состав: мазь Travocort содержит изоконазол и дифлукортолон,
Цена: Travocort 750-950 rub.
Состав: в креме и мази Pimafukort содержится неомицин,
Цена: Pimafukort 500-600 rub.
Состав: капли Candiotics содержит клотримазол, хлорамфеникол,
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
Basic solutions for topical use:
- 1% alcohol solution of fungifen;
- 0.1% alcohol solution of quinosol;
- 2% alcohol solution of flavofungin;
- 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
The main stages of preparation
- 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”.
- 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
- Apply with solutions, creams, ointments, or
bury drops, given the contraindications to the use of specific
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
- Sore ear need to pull up and back
- If the child is less than 3 years old – down and back to straighten.
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
- Make sure that the affected areas do not fall
The choice of drug, depending on the etiology and location
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||
||Locally in the form of successive applications for 10 minutes, 2 times a
|External otomycosis caused by mold fungi||
||Locally in the form of successive applications for 5-10 minutes 2 times
|Candida otitis media and mycosis of the postoperative cavity
|Fluconazole||Inside, 50-100 mg once a day||14 days|
||Locally in the form of successive applications for 5-10 minutes 2 times
|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|
||Locally in the form of successive applications for 5-10 minutes 2 times
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
- 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.
- Healthy lifestyle, hardening.
- Do not use cotton swabs, sharp objects for cleaning ear
- Take antibiotics and hormones only
- When bathing in ponds and pools to protect the ears from getting
- 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