Otomycosis (fungal otitis externa) is a fungal infection of the ear canal. Normally, bacteria and fungi live on the skin all over the body including the ear canal.
These microorganisms, called normal flora, exist in harmony and help keep each other “in check” so neither grows out of control.
Cerumen (earwax) is an oily substance produced by glands in the ear canal. It has antibacterial and antifungal abilities to protect against infections. It is hydrophobic, meaning it repels moisture from the outside world and from within (think sweat). Too much moisture can lead to fungal infections (just like athelete’s foot or jock itch). The acidic nature of earwax also helps prevent the growth of fungi and bacteria. Fungal infections of the ear canal can be mistaken for bacterial infection, and they can also occur together. These infections occur most commonly in the summer swimming season when heat, humidity, and water exposure is more prevalent.
Symptoms of otomycosis typically include:
Removing earwax with cotton-tipped swabs (Q-tips) increases the possibility of an ear canal infection because the natural protectant (ear wax or cerumen) is gone. Otomycosis occurs when there is moisture, injury to skin, and a lack of earwax to protect the ear.
Fungi that live on the skin in the ear canal need a warm, dark, moist environment to grow. The nature and shape of the ear canal allows water to remain there for a long period of time, letting humidity build up quickly when the ear canal is plugged. Sometimes, fungal infections of the ear canal occur as a result of using antibiotics. Antibiotic eardrops suppress the growth of bacteria but not the growth of fungi. When the bacteria die, the fungus has nothing to keep it “in check,” so it can grow and lead to an ear canal infection, or otomycosis.
Treatment for otomycosis involves preventing the growth of the fungus by removing the dead skin and fungal elements (debridement). This is best accomplished by a thorough cleaning of your ear canal performed by an ENT (ear, nose, and throat) specialist, and the application of an antifungal agent. Removing the dead skin and creating a dry, slightly acidic environment prevents the growth of fungi. With time, when ear wax (cerumen) builds back up, this condition is much less likely to occur.
If you have a hole in your eardrum, the options for treating otomycosis are limited. Your physician may prescribe a topical antifungal called clotrimazole or a topical antifungal powder, which helps dry the ear and kill the fungus. Some physicians use an antifungal medication called gentian violet, which some patients refer to as “the purple stuff” due to its deep purple color. One last option is an antifungal cream placed in the ear canal and left for a few days. Your physician may fill the entire ear canal with the cream, which will gradually melt and come out.
It is important to protect your ears If you have repeated fungal or bacterial infections. For instance, you may need to keep water out of your ears when bathing, showering, or swimming. It is not healthy to “clean” the ears with soap, water or Q-tips. Ear wax (cerumen) is not dirty and it serves an important function – protecting your ears. Keeping your ears dry and avoiding use of cotton-tipped swabs (Q-tips) will help avoid this problem in the future. Instead of Q-tips after bathing/showering, you can blot your ears with a dry towel and use a hair dryer (cool setting) to help evaporate excess moisture.