Primary Otomycosis in the Indian Subcontinent: Predisposing Factors, Microbiology, and Classification

Abstract

Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis. Study Design. Prospective study of two years and review of the literature. Setting. Academic Department of Otolaryngology in a coastal city in India. Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group. Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed by Penicillium (8%), Candida albicans (4%), Rhizopus (1%), and Chrysosporium (1%), the last being reported for the first time in otomycosis. Among aspergilli, A. niger complex (38%) was the most common followed by A. fumigatus complex (27%) and A. flavus complex (15%). Bacterial isolates associated with fungi in otomycosis were S. aureus, P. aeruginosa, and Proteus spp. In 42% of healthy external ears fungi were isolated. Conclusion. Aspergillus spp. were the most common fungi isolated, followed by Penicillium. Otomycotic ears are often associated with bacterial isolates when compared to normal ears. Fungi are also present in a significant number of healthy external auditory canals and their profiles match those in cases of otomycosis. The use of terms “primary” and “secondary” otomycosis is important to standardize reporting.

Otomycosis – A Clinico-pathological Study

“…In most of the studies otomycosis involves only one and mostly the right ear. 2,12,14 In this study unilateral otomycosis was seen in 73.78% patients complimenting the already reported observations. This phenomenon is believed to be due to the right handedness of most of the patients with habit of ear poking, but same findings are not found in other studies.…”

“…The condition is more common in males and same pattern is noted in current series. 2,4,12,13 The possible reason may be more exposure of males to fungal spores due to outdoor work. In most of the studies otomycosis involves only one and mostly the right ear.…”

A Clinico-Mycological Study of Otomycosis From a Tertiary Care Hospital in Western Uttar Pradesh

“…1,6,12 Studies from Karnataka and Pakistan have reported it to be more common in males as in our study. 1,6,7,13 whereas studies from Nigeria, Brazil, Iran, Shanghai and Haryana have reported it to be more common among young females. 2.14 In our series, the ratio was 1.04:1.…”

“…The case control study was planned because fungi are also isolated from healthy ears. 6 Approval from the Institutional Ethical and Research Committee was obtained before conducting the study.…”

“…3,4,5 Although literature search reveals Aspergillus niger as the most common agent of otomycosis, a wide variety of other fungi can cause otomycosis. 1,2,6,7,8 Despite the fact that our climatic conditions may encourage otomycosis, there is a dearth of literature and limited knowledge on this disease entity in our environment, hence, the need to create awareness among healthcare providers and the entire populace on this disease. Therefore, the study was carried out with the objective to determine the predisposing factors, symptoms, and to identify the fungus and secondary bacterial infection both in the study and control groups.…”