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U.P. S, Parveen HJ, Nasser A, Kuruwatti A, Vaibhava SV. Incidence of KOH Positive Elements in Chronic Discharging Ear -A Retrospective Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2777-2780. [PMID: 37974709 PMCID: PMC10645948 DOI: 10.1007/s12070-023-03864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/04/2023] [Indexed: 11/19/2023] Open
Abstract
The term chronic suppurative otitis media (CSOM) refers to middle ear infections lasting more than three months that lead to perforated tympanic membrane. Low socioeconomic strata of the society are more likely to have the disease in developing countries. There have been many studies focusing on the bacterial flora of CSOM, but little is known about the mycological aspects, which have become increasingly important over the last few decades. The present study was aimed to speculate the presence of fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center. This retrospective study was conducted in a tertiary care centre after taking the approval of the protocol review committee and institutional ethics committee. Total 100 Patients of chronic otitis media were included with no history using ear drops for last one week and using two sterile swab without touching the external auditory canal, discharge was taken from middle ear and placed in sterile container and sent for potassium hydroxide (KOH) mount and observed. The age ranged from 18 months to 87 years and the mean age was 37.27+/- 12.59 years. The study population of male is 42 (41.6%) and female is 59 (58.4%). Distribution of KOH positivity observed for 33 (32.7%) and KOH negative for the study population of 68 (67.3%). When antibacterial treatment does not seem to relieve persistent otorrhea, otologists should suspect mycotic otitis media probable cause.
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Affiliation(s)
- Santosh U.P.
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - H. Jemima Parveen
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | | | - Ashwini Kuruwatti
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
| | - Sri V. Vaibhava
- Department of Otorhinolaryngology, J J M Medical College, Davangere, Karnataka India
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McCarty Walsh E, Hanson MB. Fungal Infections of the External Auditory Canal and Emerging Pathogens. Otolaryngol Clin North Am 2023; 56:909-918. [PMID: 37553272 DOI: 10.1016/j.otc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Fungal infections of the external auditory canal can range from common (otomycosis) to life threatening (necrotizing otitis externa). Proper identification of fungal pathogens is necessary to guide appropriate therapy, and a high index of suspicion for fungal causes of ear canal disease is critical. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients. Opportunistic fungal infections of the ear canal are an emerging concern.
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Affiliation(s)
- Erika McCarty Walsh
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Matthew B Hanson
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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3
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Bojanović M, Stalević M, Arsić-Arsenijević V, Ignjatović A, Ranđelović M, Golubović M, Živković-Marinkov E, Koraćević G, Stamenković B, Otašević S. Etiology, Predisposing Factors, Clinical Features and Diagnostic Procedure of Otomycosis: A Literature Review. J Fungi (Basel) 2023; 9:662. [PMID: 37367598 DOI: 10.3390/jof9060662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC) with a worldwide prevalence ranging from 9% to 30%. Commonly, otomycoses are caused by Aspergillus (A.) niger complex and Candida spp. Other causative agents are yeasts of the genera Cryptococcus spp., Rhodotorula spp., Geotrichum candidum, dermatophytes (Trichophyton mentagrophytes), and non-dermatophytes molds (Fusarium spp., Penicillium spp., Mucorales fungi). The widest range of different species causing OM are found in the territories of Iran, India, China, Egypt, Mexico, and Brazil. Fungal infection of the EAC varies from mild to severe forms. It can be acute, subacute, or chronic, and is often unilateral, while the bilateral form is more common in immunocompromised patients. From an epidemiological point of view, tropical and subtropical climates are the most significant risk factor for the development of otomycosis. Other predisposing conditions include clothing habits, EAC hygiene practices, long-term antibiotic therapy, diabetes, and immunodeficiency. Since it is often difficult to distinguish otomycosis from an infection of a different origin, laboratory-based evidence, including standard procedures (microscopy and cultivation), is essential for diagnosis. For the treatment of this superficial fungal infection, there are no official therapeutic guidelines and protocols. However, many antifungals for local application, such as polyene, imidazoles, and allylamines, can be applied, as well as systemic antimycotics (triazoles) in severe forms of infection.
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Affiliation(s)
- Mila Bojanović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Marko Stalević
- Medical Faculty, University of Priština in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | | | - Aleksandra Ignjatović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Marina Ranđelović
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
| | | | - Emilija Živković-Marinkov
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Goran Koraćević
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- University Clinical Center Niš, 18000 Niš, Serbia
| | - Bojana Stamenković
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Institute For Treatment and Rehabilitation "Niška Banja", 18205 Niš, Serbia
| | - Suzana Otašević
- Medical Faculty, University of Niš, 18000 Niš, Serbia
- Public Health Institute Niš, 18000 Niš, Serbia
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4
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Roohi B, Nemati S, Alipour A, Faeli L, Mayahi S, Haghani I, Shalchizadeh M, Darini A, Al-Hatmi AMS, Abastabar M, Shokohi T. Otomycosis: The foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in North-Western Iran. Mycoses 2023; 66:87-97. [PMID: 36134511 DOI: 10.1111/myc.13532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth. OBJECTIVES The study aimed to identify the causative agents of otomycosis and determine corresponding antifungal drug susceptibility patterns in north-western Iran. METHODS From October 2020 until November 2021, 200 patients attended an otolaryngology referral centre with otitis externa, and their ear discharge and debris were examined and cultured. The identification of the fungal agents was implemented by polymerase chain reaction-restriction fragment length polymorphism and sequencing. In vitro antifungal susceptibility testing of the isolates was conducted in accordance with the CLSI broth microdilution protocols. RESULTS The prevalence of otomycosis was measured 50.5% (n = 101/200). The majority of patients were in their forties (n = 35, 34.6%) and female (n = 57, 56.4%), and the most prevalent symptom was otalgia (56.4%). The most underlying factor was remarked manipulation employing a cotton swab (65.3%). Regarding fungus, Aspergillus section Nigri (58.57%) was the foremost isolate, followed by Aspergillus section Flavi (19.23%) and Candida parapsilosis (14.96%). The predominance of Aspergillus isolates had minimal in vitro sensitivity to tioconazole and nystatin. Candida species represented higher geometric mean minimum inhibitory concentrations (MIC) against nystatin. The MIC of three Aspergillus species isolates shown above the epidemiologic cut-off values (ECV) against itraconazole. CONCLUSIONS Otomycosis incidence surpassed in comparison with the previous study as the most common cause of otitis externa. The MIC distribution of Aspergillus species isolates against triazole antifungals is close to the defined ECVs and likely outrun it over time.
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Affiliation(s)
- Behrad Roohi
- Communicable Diseases Institute, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shadman Nemati
- Department of Otolaryngology and Head and Neck Surgery, Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Alipour
- Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Faeli
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sabah Mayahi
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Haghani
- Communicable Diseases Institute, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Makan Shalchizadeh
- Department of Otolaryngology and Head and Neck Surgery, Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Darini
- Department of Otolaryngology and Head and Neck Surgery, Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdullah M S Al-Hatmi
- Natural & Medical Science Research Center, University of Nizwa, Nizwa, Oman.,Center of Expertise in Mycology of Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Mahdi Abastabar
- Communicable Diseases Institute, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Communicable Diseases Institute, Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Chavan RP, Ingole SM, Kanchewad Resident GS. Single Topical Application of 1% Clotrimazole Cream in Otomycosis. Indian J Otolaryngol Head Neck Surg 2022; 75:147-154. [PMCID: PMC9734867 DOI: 10.1007/s12070-022-03206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/23/2022] [Indexed: 12/13/2022] Open
Abstract
Aim: To assess the clinical improvement after single dose topical application of 1% clotrimazole cream in otomycosis and follow up for recurrence at the end of first and the third month. Materials and Methods: A prospective observational study was carried out at Government Medical college hospital. Patients with KOH diagnosed fungal infection of external auditory canal were included in the study. After obtaining informed written consent from the participating patients, a detail clinical history was taken. Single topical application of 1% clotrimazole cream in otomycosis. The fungal debris was removed with the help of suction aspiration and dry mopping. A single topical application of 1% clotrimazole cream was applied under all aseptic precautions. On the 3rd day the applied cream was cleaned with help of suction under ear microscope. Patients were advised to follow up after one month and three months. During each follow up patients were assessed clinically and examined for residual fungal debris. Result: Otomycosis was seen predominantly in middle aged females, housewives and laborers by occupation. Earache was most common symptom seen in 65.2%. Unilateral involvement was seen in 89.3% cases. The most common organism isolated in otomycosis was Aspergillus niger. At the end of one month of treatment with a single dose of 1% clotrimazole cream, 102 (91.0%) patients were recovered and 10 (9.0%) patients were with persistence or recurrence of the symptoms. At the end of third month, the recovery rate was 84.8% and recurrence rate was 6.3%. Conclusion: Single topical application of 1% clotrimazole cream is effective in treating otomycosis.
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Affiliation(s)
- Reshma P. Chavan
- grid.466718.a0000 0004 1802 131XDepartment of ENT, GMC Miraj, Miraj, Maharashtra India
| | - Shivraj M. Ingole
- Department of Radiology, GGMC and Sir J.J group of Hospitals, Mumbai, Maharashtra India
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Isolation, Characterization, and Antifungal Sensitivity Pattern of Fungal Species with Potential Resistance to Antifungal Drugs in Patients with Otomycosis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-129169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Otomycosis is defined as a superficial fungal infection, accounting for about 10% of infectious otitis externa cases. Objectives: This study investigated patients with suspicious symptoms through the examination of their demographic information, isolate etiological agents, and in vitro antifungal susceptibility patterns. Methods: The samples of 170 patients with otitis externa symptoms were collected and confirmed for otomycosis by mycological examination (e.g., potassium hydroxide, methylene blue staining, and fungal culture) and molecular sequencing. In vitro antifungal susceptibility tests against miconazole, fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, and caspofungin were performed according to the Clinical and Laboratory Standards Institute (M27-A3/S4 and M38-A2). Results: Out of 170 patients, 145 subjects (85.29%) showed positive mycological findings. In this study, 55.8% of the patients were male, and the most common age group affected was 50 - 59 years (26.2%). Hearing loss and pruritus were the most common clinical manifestations. The most common occupation was being a housewife (47.5%), and most cases occurred during the winter (40%). Aspergillus niger was the most common species, followed by Aspergillus fumigatus, Candida albicans, and Candida glabrata. Caspofungin showed the highest activity against Aspergillus and Candida isolates; nevertheless, itraconazole demonstrated the lowest activity against Aspergillus isolates. Fluconazole showed the weakest power against Candida species. Conclusions: Due to climatic conditions, humidity, and dust, otomycosis has a high occurrence in Iran. Although otomycosis needs long-term antifungal therapy and recurrence is high in some cases, it is rarely life-threatening, and eardrop antifungals are usually enough to eradicate the infection. Local information about the antifungal pattern is useful for the control, prevention, and treatment of otomycosis.
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Haq M, Deshmukh P. Review of Recurrent Otomycosis and Clotrimazole in Its Treatment. Cureus 2022; 14:e30098. [DOI: 10.7759/cureus.30098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
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Isolation and identification of Aspergillus fumigatus from Immunocompromised patients in AL- Najaf Province. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns1.6240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The present study was conducted to isolation and identification of Aspergillus fumigatus. Isolated from immunocompromised patients with (Diabetes, Cancer) by different identification methods including direct examination, laboratory culture and electron microscopy. During the period from (July to September 2016), a total of 50 swab were collected from immunocompromised patients with attending to the in AL- Sadder Medical City (the Center for Diabetes and Endocrinology) and (Euphrates middle Center for cancer diseases). In AL-Najaf Governorate, the samples were collected as following: 30 swab from the eyes of cancer patients who were suffering from prostate, leukemia, stomach and intestines cancer, also 20 swabs from the ears of diabetic patients. The percentage of female to male was as following, 29 females (58%) males and 21 (42%). In this study, the results show that the incidence of aspergillosis in women was higher than the male. The results of the present study reveal that the prevalence of aspergillosis from patient with cancer was more than diabetes patients which was 18 (66.66%) and 9 (33.33%), respectively.
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Javidnia J, Ghotbi Z, Ghojoghi A, Solhjoo K, Alshahni MM, Jeddi SA, Ahmadi B, Nouripour-Sisakht S, Ansari S, Shokoohi G. Otomycosis in the South of Iran with a High Prevalence of Tympanic Membrane Perforation: A Hospital-Based Study. Mycopathologia 2022; 187:225-233. [PMID: 35347533 DOI: 10.1007/s11046-022-00626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Otomycosis is a superficial infection of the external ear caused by fungal pathogens. The genera Aspergillus and Candida are considered the main fungal causative agents, with the predominance of Aspergillus section Nigri. The present study aimed to evaluate the clinical symptoms of patients with otomycosis and predisposing factors and to identify fungal etiological agents using molecular approaches. We also present an overview of published papers on tympanic membrane perforation (TMP) secondary to otomycosis. MATERIALS AND METHODS An otorhinolaryngologist collected specimens from external ear canals of patients with suspected otomycosis based on the patient's history and clinical examinations. The specimens were collected using sterile swabs. Fungal isolates were confirmed in clinical specimens by direct microscopy and culture methods. Fungal isolates were identified based on molecular approaches. RESULTS In total, specimens from 211 patients with suspected otomycosis were examined. The presence of fungi was confirmed in about 51% of patients based on fungal elements in direct microscopy and culture-positive fungi. Aspergillus tubingensis was the most commonly isolated species (52.77%), followed by Aspergillus niger (25.92%). Otomycosis due to infection with Candida species was observed in 16% of cases. Of note, in 36.11% of cases, otomycosis was associated with TMP. CONCLUSION A mycological examination is indispensable for a correct diagnosis in patients with otitis extern. TMP should be considered in patients with otomycosis, as it appears to be relatively common in this population.
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Affiliation(s)
- Javad Javidnia
- Student Research Committee Center, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Ghotbi
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kavous Solhjoo
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran.,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Seyed Ali Jeddi
- Department of Laboratory Sciences, School of Allied Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, Faculty of Paramedical, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Saham Ansari
- Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamreza Shokoohi
- Zoonosis Research Center, Jahrom University of Medical Sciences, Jahrom, Iran. .,Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
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Bojanović M, Ignjatović A, Stalević M, Arsić-Arsenijević V, Ranđelović M, Gerginić V, Stojanović-Radić Z, Stojković O, Živković-Marinkov E, Otašević S. Clinical Presentations, Cluster Analysis and Laboratory-Based Investigation of Aspergillus Otomycosis—A Single Center Experience. J Fungi (Basel) 2022; 8:jof8030315. [PMID: 35330316 PMCID: PMC8948793 DOI: 10.3390/jof8030315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/05/2023] Open
Abstract
Species of Aspergillus (A.) niger complex and A. flavus complex are predominant molds that are causative agents of otomycoses. The goal of this study was to investigate the clinical presentation, diagnostic procedure, and appearance of relapse in patients with Aspergillus-otomycosis, as well as to determine the biofilm production ability of species isolated in relapse. Thirty patients with laboratory evidenced Aspergillus-otomycosis followed by two check-ups (30 and 60 days after initiation of treatment with antimycotics for local application) were included in the study. For isolation and identification of Aspergillus spp. the standard mycological procedure was applied. Results showed very high sensitivity of microscopy, but 16.7% Aspergillus species required the optimal temperature of 27–28 °C for cultivation. Applied statistical cluster analysis showed a defined specific cluster/group of patients with A. niger complex-otomycosis. Sixty days after diagnosis and treatment initiation, six patients had a relapse, with the same species of Aspergillus genus being the cause. To establish the ability of biofilm production, the modified method described by Pierce and Kvasničková was performed, and all six species isolated in the relapse episode had the ability to produce biofilm. Official criteria and recommendations are needed due to the possibility of misdiagnosis, which leads to the prolongation and complication of the disease.
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Affiliation(s)
- Mila Bojanović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Clinic of Otorhinolaryngology, University Clinical Center Niš, 18000 Niš, Serbia
| | - Aleksandra Ignjatović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Marko Stalević
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
| | | | - Marina Ranđelović
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
| | - Vladimir Gerginić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (V.A.-A.); (V.G.)
| | - Zorica Stojanović-Radić
- Department of Biology, Faculty of Science and Mathematics, University of Niš, 18000 Niš, Serbia; (Z.S.-R.); (O.S.)
| | - Ognjen Stojković
- Department of Biology, Faculty of Science and Mathematics, University of Niš, 18000 Niš, Serbia; (Z.S.-R.); (O.S.)
| | - Emilija Živković-Marinkov
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Clinic of Otorhinolaryngology, University Clinical Center Niš, 18000 Niš, Serbia
| | - Suzana Otašević
- Medical Faculty, University of Niš, 18000 Niš, Serbia; (M.B.); (A.I.); (M.S.); (M.R.); (E.Ž.-M.)
- Public Health Institute Niš, 18000 Niš, Serbia
- Correspondence: ; Tel.: +381-184-226-384
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Alshahni MM, Alshahni RZ, Fujisaki R, Tamura T, Shimizu Y, Yamanishi C, Makimura K. A Case of Topical Ofloxacin-Induced Otomycosis and Literature Review. Mycopathologia 2021; 186:871-876. [PMID: 34410567 DOI: 10.1007/s11046-021-00581-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The prevalence of fungal otitis externa, or otomycosis, has been increasing in recent decades. Fungi may act as primary pathogens in this condition, or they may occur as secondary infections after prolonged ototopical treatment with antibiotics, which alters the flora of the external auditory canal (EAC) and enables overgrowth of its fungal inhabitants. We report here a case of otomycosis by Candida parapsilosis, Malassezia obtusa, and Malassezia furfur as a secondary infection following prolonged otic ofloxacin treatment. To the best of our knowledge, although isolation of C. parapsilosis and M. furfur from the EAC is not uncommon, the recovery of M. obtusa has not yet been reported. We also conducted a literature review of the searchable data on PubMed concerning the isolation of Malassezia species from the human EAC.
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Affiliation(s)
- Mohamed Mahdi Alshahni
- Laboratory of Medical Mycology and Space Environmental Medicine, School of Medicine, Graduate School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan.,Department of AMR Mycosis Control Research in the Environment of Treatment and Education for Physically and Mentally Handicapped Persons, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | | | - Ryuichi Fujisaki
- Department of Sports and Medical Science, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo, Japan
| | - Takashi Tamura
- Teikyo University Institute of Medical Mycology, Tokyo, Japan
| | - Yuya Shimizu
- Department of Otolaryngology, Teikyo University Hospital, Itabashi, Tokyo, Japan
| | | | - Koichi Makimura
- Laboratory of Medical Mycology and Space Environmental Medicine, School of Medicine, Graduate School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, 173-8605, Japan. .,Department of AMR Mycosis Control Research in the Environment of Treatment and Education for Physically and Mentally Handicapped Persons, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan. .,Teikyo University Institute of Medical Mycology, Tokyo, Japan.
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12
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Prepageran Narayanan
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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13
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Mofatteh MR, Ahi Fersheh M, Nikoomanesh F, Namaei MH. Comparing the Therapy of Otomycosis Using Clotrimazole with Iodine Tincture: A Clinical Trial. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2021; 33:229-235. [PMID: 34395323 PMCID: PMC8339887 DOI: 10.22038/ijorl.2021.51647.2751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 06/14/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Otomycosis, as a common superficial fungal infection, is the term to infection of external auditory canal. Despite numerous studies on diverse antifungal agents, there is no common consent on effective agent for treatment of otomycosis. Therefore, the purpose of this study is compared therapy of otomycosis using two therapeutic agents; clotrimazole and iodine tincture. MATERIALS AND METHODS This research is a clinical trial study included 160 patients who were presented otomycosis. All patients were randomly assigned into two therapeutic groups of clotrimazole and Iodine Tincture (80 cases in each group). The results of response to thrapy were evaluated on 4, 10, and 20 days. Statistical analyses were performed using Independent-Samples t-test, Chi-Square, and Fishers҆ Exact tests in SPSS software v.18, in 0.05 significant level. RESULTS Fungal species were isolated including Aspergillus (72.5%) and Candida albicans (22.5%). After 4thday of treatment, 7.5% of the tincture group and 11.2% of the clotrimazole group revealed a good response to treatment (P=0.30). A good response to treatment was observed in35.0 and 41.2% of the patients on 10th day of treatment (P=0.44); and in 67.5 and 62.5% of the patients on 20th day of treatment (P= 0.20). There was no significant relationship between the two therapeutic arms. CONCLUSION In this study, both clotrimazole and tincture showed the identical therapeutic efficacy on otomycosis. Our findings suggested that tincture can be used as a supplementary antifungal option for treatment of otomycosis.
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Affiliation(s)
- Mohammad Reza Mofatteh
- Department of Ears Nose and Throat, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.
| | | | - Fatemeh Nikoomanesh
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
| | - Mohammad Hasan Namaei
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Abstract
BACKGROUND Otomycosis is a fungal infection of the outer ear, which may be treated with topical antifungal medications. There are many types, with compounds belonging to the azole group ('azoles') being among the most widely used. OBJECTIVES To evaluate the benefits and harms of topical azole treatments for otomycosis. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The search date was 11 November 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adults and children with otomycosis comparing any topical azole antifungal with: placebo, no treatment, another type of topical azole or the same type of azole but applied in different forms. A minimum follow-up of two weeks was required. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were: 1) clinical resolution as measured by the proportion of participants with complete resolution at between two and four weeks after treatment (however defined by the authors of the studies) and 2) significant adverse events. Secondary outcomes were 3) mycological resolution and 4) other less serious adverse effects. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included four studies with 559 participants from Spain, Mexico and India. Three studies included children and adults; one included only adults. The duration of symptoms was not always explicitly stated. Mycological resolution results were only reported in one study. The studies assessed two comparisons: one type of topical azole versus another and the same azole but administered in different forms (cream versus solution). A. Topical azoles versus placebo None of the studies assessed this comparison. B. Topical azoles versus no treatment None of the studies assessed this comparison. C. One type of topical azole versus another type of topical azole i) Clotrimazole versus other types of azoles (eberconazole, fluconazole, miconazole) Three studies examined clotrimazole versus other types of azoles. The evidence is very uncertain about the difference between clotrimazole and other types of azole in achieving complete clinical resolution at four weeks (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.07; 3 studies; 439 participants; very low-certainty evidence). The anticipated absolute effects are 668 per 1000 for clotrimazole versus 835 per 1000 for other azoles. One study planned a safety analysis and reported no significant adverse events in either group. The evidence is therefore very uncertain about any differences between clotrimazole and other types of azole (no events in either group; 1 study; 174 participants; very low-certainty evidence). Clotrimazole may result in little or no difference in mycological resolution at two weeks follow-up (RR 1.01, 95% CI 0.96 to 1.06; 1 study; 174 participants; low-certainty evidence) or in other (less serious) adverse events at two weeks follow-up (36 per 1000, compared to 45 per 1000, RR 0.79, 95% CI 0.18 to 3.41; 1 study; 174 participants; very low-certainty evidence). ii) Bifonazole cream versus bifonazole solution One study compared bifonazole 1% cream with solution. Bifonazole cream may have little or no effect on clinical resolution at two weeks follow-up when compared to solution, but the evidence is very uncertain (RR 1.07, 95% CI 0.73 to 1.57; 1 study; 40 ears; very low-certainty evidence). Bifonazole cream may achieve less mycological resolution compared to solution at two weeks after the end of therapy, but the evidence for this is also very uncertain (RR 0.53, 95% CI 0.29 to 0.96; 1 study; 40 ears; very low-certainty evidence). Five out of 35 patients sustained severe itching and burning from the bifonazole solution but none with the bifonazole cream (very low-certainty evidence). AUTHORS' CONCLUSIONS We found no studies that evaluated topical azoles compared to placebo or no treatment. The evidence is very uncertain about the effect of clotrimazole on clinical resolution of otomycosis, on significant adverse events or other (non-serious) adverse events when compared with other topical azoles (eberconazole, fluconazole, miconazole). There may be little or no difference between clotrimazole and other azoles in terms of mycological resolution. It may be difficult to generalise these results because the range of ethnic backgrounds of the participants in the studies is limited.
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Affiliation(s)
- Ambrose Lee
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Shakeel R Saeed
- UCL Ear Institute & The Royal National Throat, Nose & Ear Hospital, Royal Free Hampstead NHS Foundation Trust, London, UK
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15
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Kiakojuri K, Mahdavi Omran S, Roodgari S, Taghizadeh Armaki M, Hedayati MT, Shokohi T, Haghani I, Javidnia J, Kermani F, Badali H, Abastabar M. Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis. Mycopathologia 2021; 186:245-257. [PMID: 33718990 DOI: 10.1007/s11046-021-00537-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022]
Abstract
Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10-20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.
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Affiliation(s)
- Keyvan Kiakojuri
- Department of Ear, Nose, and Throat, Faculty of Medicine, Roohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Saeid Mahdavi Omran
- Department of Medical Mycology, School of Medicine, Babol University of Medical Sciences, 47745-47176, Babol, Iran.
| | - Somayeh Roodgari
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Taghizadeh Armaki
- Department of Medical Mycology, School of Medicine, Babol University of Medical Sciences, 47745-47176, Babol, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.,Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Badali
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. .,Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, 48175-1665, Sari, Iran.
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Sangaré I, Amona FM, Ouedraogo RWL, Zida A, Ouedraogo MS. Otomycosis in Africa: Epidemiology, diagnosis and treatment. J Mycol Med 2021; 31:101115. [PMID: 33516991 DOI: 10.1016/j.mycmed.2021.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
This review sets out to highlighted knowledge gaps regarding the epidemiological, diagnostic (clinical and laboratory) and therapeutic aspects of otomycosis in Africa. A computerized literature search for otomycosis related articles were performed using MEDLINE. The search encompassed articles published in early January 1980 to May 2019 yielded 220 articles. Electronic search on PubMed was performed with the specific keywords. This review shows the higher prevalence rates of otomycosis in Africa. These prevalences varies from one country to the other and also from one population to another within the same country. The main symptoms are otalgia, otorrhea, hearing loss, aural fullness, pruritus, and tinnitus. Otomycosis is due to several predisposing factors, however, use of topical antibiotic/steroid eardrops, trauma to the external ear canal or instrumentation of the ear, being exposed to hot humid atmospheres, and close contact with water are the common risk factors. Aspergillus species are the most commonly identified organisms compared with Candida species. Worldwide, A. niger and C. albicans are the most commonly described agents of otomycosis in Africa. The Laboratory diagnosis of otomycosis is usually confirmed by mycologic tests relied on a set of evidences. Further conventional methods such as Chromagar Candida System, latex agglutination test, Biochemical tests (Api 20C AuxTM and auxanogram), phenotypical tests (Germ-tube and chlamydosporulation), and rRNA gene sequencing (PCR) are performed to improve diagnosis and the management of the disease. Adequate treatment of otomycosis includes microscopic suction clearance of fungal mass, discontinuation of topical antibiotics and treatment with antifungal eardrops for three weeks.
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Affiliation(s)
- Ibrahim Sangaré
- Institut Superieur des Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso; Laboratoire de Parasitologie-Entomologie, Centre MURAZ, Bobo-Dioulasso, Burkina Faso; Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso.
| | - Fructueux Modeste Amona
- Institut Superieur des Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | | | - Adama Zida
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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Chen Q, Chu H, Tao Y, Peng L, Zhou L, Liu L, Wu X. A Comparison of Triamcinolone Acetonide Econazole Cream and Nystatin Suspension in Treatment of Otomycosis. Laryngoscope 2020; 131:E1640-E1646. [PMID: 33141477 DOI: 10.1002/lary.29190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/05/2020] [Accepted: 10/05/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To compare the efficacy and adverse effects of triamcinolone acetonide econazole cream and nystatin suspension in the treatment of otomycosis, and to determine the clinical features, predisposing factors, and etiology of otomycosis. STUDY DESIGN A prospective study. METHODS A prospective clinical trial was conducted on 786 patients diagnosed with otomycosis. The study population was randomly divided into two treatment groups of triamcinolone acetonide econazole cream (TAEC) and nystatin suspension in a 1:1 ratio. After clearing all fungal deposits in the external auditory canal, the antimycotic drugs were locally applied for at least 2 weeks. The efficacy and adverse effects were compared between the two antifungal reagents by statistical analysis. Meanwhile, patient clinical data were collected to find out the clinical features, predisposing factors, and etiology. RESULTS Pruritis was the most common symptom and Aspergillus niger was the leading fungal pathogen. There was high association (44.5%) of otomycosis with a history of unclean ear picking. The cure rate was 97.6% in the TAEC group and 73.5% in the nystatin group (P < .01). Treatment with TAEC resulted in 2.4% of patients complaining of discomforts (irritant dermatitis, otalgia, or headache) versus 59.8% of patients complaining discomforts treated with nystatin (P < .01). The residue rate of antifungals was 1.9% in the TAEC group and 89.9% in the nystatin group (P < .01) at the end of treatment. CONCLUSIONS Thoroughly cleaning of the external auditory canal followed by local use of TAEC under endotoscope is an effective, convenient, and well-tolerated treatment for otomycosis. LEVEL OF EVIDENCE 1 Laryngoscope, 131:E1640-E1646, 2021.
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Affiliation(s)
- Qingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanqi Chu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Tao
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liyan Peng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangqiang Zhou
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Liu
- Department of Otolaryngology-Head and Neck Surgery, Tianyou Hospital Affiliated to Wuhan University of Science & Technology, Wuhan, China
| | - Xiaohui Wu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Rizk HG, Lee JA, Liu YF, Endriukaitis L, Isaac JL, Bullington WM. Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide. Pharmacotherapy 2020; 40:1265-1275. [PMID: 33080070 DOI: 10.1002/phar.2478] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In an era of increasing polypharmacy, adverse drug effects such as ototoxicity have significant public health implications. Despite the availability of evidence, many health care professionals may not know the risk of ototoxicity in common medications. Therefore, the aim of this review is to provide a comprehensive, easy to use, ototoxic profile of medications with an assessment of supporting evidence. METHODS Medications of interest were identified through adverse drug reaction reports derived from Micromedex (IBM), Lexicomp (Wolters Kluwer), and the textbook, Drug Induced Diseases: Prevention, Detection, and Management. Additional evidence was identified though a query of PubMed and the Cochrane database. Evidence of causality was graded according to the following: A (randomized, controlled clinical trials), B (nonrandomized clinical trials, prospective observational studies, cohort studies, retrospective studies, case-controlled studies, and/or postmarketing surveillance studies), and C (case reports/case series). RESULTS A total of 194 systemically administered medications associated with ototoxicity were identified, most commonly antimicrobials (53), psychotropics (21), antihypertensive/antiarrhythmics (19), nonsteroidal antiinflammatory drugs (18), and antineoplastics (16). There was evidence of cochleotoxicity in 165 medications (evidence grading A [22], B [77], C [69]), vestibulotoxicity in 100 medications (evidence grading A [23], B [47], and C [30]), and dizziness in 142 medications (evidence grading A [50], B [76], and C [16]). In addition, a review of the evidence of ototoxicity in ototopical medications is also reviewed. CONCLUSION The effect and severity of ototoxicity can vary immensely depending on pharmacological and individual patient risk factors. The intent of this comprehensive review was to help health care providers of all sectors obtain a deeper knowledge of drug-induced ototoxicity to make more informed management decisions for their patients.
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Affiliation(s)
- Habib G Rizk
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joshua A Lee
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Yuan F Liu
- Department of Otolaryngology - Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, USA
| | - Lauren Endriukaitis
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Julianne L Isaac
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Wendy M Bullington
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina, USA
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The changing nature of paediatric otomycosis in the mid-west of Ireland. The Journal of Laryngology & Otology 2020; 134:592-596. [PMID: 32713390 DOI: 10.1017/s0022215120001164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fungal otitis externa is prevalent in tropical and sub-tropical climates; however, over the past two decades, there has been a reported increase in the prevalence of otomycosis in paediatric patients from more temperate climates. This study aimed to review the children diagnosed with otomycosis at the University Hospital Limerick with reference to frequency, causative organism, predisposing factors and management. METHODS A retrospective review was conducted of paediatric patients from 2001 to 2015. Patients with positive fungal ear swabs and a diagnosis of otomycosis were identified. RESULTS Ninety-three patients were positive for candida (mean age, 5.8 years), 10 patients were positive for aspergillus (mean age, 9.1 years) and 1 patient had mixed fungal infection containing both fungi. There was a positive correlation between a diagnosis of otomycosis and prior treatment with topical fluoroquinolones (r = 0.8; p < 0.01). CONCLUSION The incidence of otomycosis has been increasing since 2001, which correlates with an increase in the use of topical fluoroquinolones. Previous studies identify aspergillus as the commonest causative fungi; however, this study found that candida was the commonest isolated fungi in the paediatric population.
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Jimenez-Garcia L, Celis-Aguilar E, Díaz-Pavón G, Muñoz Estrada V, Castro-Urquizo Á, Hernández-Castillo N, Amaro-Flores E. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial. Braz J Otorhinolaryngol 2020; 86:300-307. [PMID: 30826311 PMCID: PMC9422661 DOI: 10.1016/j.bjorl.2018.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Otomycosis, an infection of the ear canal by fungi, is prevalent in hot and humid weather. Nevertheless, there is not sufficient evidence for the effectiveness of different topical antifungal treatments. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Currently there are not sufficient studies that prove its efficacy. Objectives To compare the efficacy of clotrimazole and tolnaftate administration in the treatment of otomycosis. Material and methods A controlled, randomized and open clinical trial included patients diagnosed with fungal external otitis who were treated with topical antifungals, randomized into two treatment groups: (1) clotrimazole cream; (2) tolnaftate solution. They were microscopically evaluated at one and two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed. Follow-up and final outcomes (absence of infection) were compared between groups. Results Forty eight patients were included, 28 in the clotrimazole group and 20 in the tolnaftate group. Spring was the weather most commonly associated with otomycosis, while otic manipulation was the risk factor more common in both groups. Predominant symptoms were itching and otic fullness. Aspergillus niger organism was isolated most frequently. Treatment with clotrimazole resulted in 75% resolution vs 45% resolution with treatment with tolnaftate at one week of treatment (p = 0.007). The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures, 20% and 15% respectively. Conclusions Clotrimazole cream treatment is more effective than tolnaftate for uncomplicated otomycosis. More studies are needed to corroborate our results.
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Affiliation(s)
- Lesly Jimenez-Garcia
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico
| | - Erika Celis-Aguilar
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico.
| | - Gaudencio Díaz-Pavón
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico
| | - Victor Muñoz Estrada
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Mycology Department, Culiacán, Mexico
| | - Ángel Castro-Urquizo
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico
| | - Nemiliztli Hernández-Castillo
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico
| | - Ernesto Amaro-Flores
- Universidad Autónoma de Sinaloa, Centro de Investigación y Docencia en Ciencias de la Salud, Otolaryngology Department, Culiacán, Mexico
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Zhang L, Wang X, Houbraken J, Mei H, Liao W, Hasimu H, Liu W, Deng S. Molecular Identification and In Vitro Antifungal Susceptibility of Aspergillus Isolates Recovered from Otomycosis Patients in Western China. Mycopathologia 2020; 185:527-535. [DOI: 10.1007/s11046-020-00448-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
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Gharaghani M, Halvaeezadeh M, Ali Jalaee G, Taghipour S, Kiasat N, Zarei Mahmoudabadi A. Antifungal susceptibility profiles of otomycosis etiological agents in Ahvaz, Iran. Curr Med Mycol 2020; 6:18-22. [PMID: 33628977 PMCID: PMC7888522 DOI: 10.18502/cmm.6.2.2696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Otomycosis is a secondary ear fungal infection among predisposed individuals in humid conditions. Aspergillus species are the most common etiologic agents of this infection. Several ototopical antifungals are currently used for the treatment of this disease; however, recurrence and treatment failure are usually observed in some cases. Regarding this, the present study was conducted to investigate the antifungal activity of caspofungin, azoles, and terbinafine against the isolated agents of otomycosis. Materials and Methods This study was conducted on the specimens collected from 90 patients with otomycosis. The samples were cultured on Sabouraud dextrose agar and identified based on morphological characteristics, physiological tests, and microscopic features. Furthermore, the microdilution method was used for antifungal susceptibility testing according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Finally, the minimum inhibitory concentration (MIC) and minimum effective concentration (MEC) ranges, MIC/MEC50, MIC/MEC90, and geometric mean (GM) MIC/MEC were calculated for the isolates. Results According to the results, 77 patients with otomycosis were positive for different Aspergillus (88.3%) and Candida (11.7%) species. Aspergillus niger complex (n=36) was found to be the most common agent, followed by A. flavus, A. terreus, and A. nidulans complexes. Furthermore, epidemiological cutoff values (ECVs) were lower than those presented by the CLSI for itraconazole and caspofungin in 98.5% and 42.6% of Aspergillus species, respectively. Terbinafine exhibited a great activity against Aspergillus species, while fluconazole revealed a low activity against both Aspergillus species. Based on the results, 77.8% of Candida species were resistant to caspofungin; however, miconazole and econazole had low MIC ranges. Conclusion Aspergillus niger and A. flavus complexes were identified as the most common agents accounting for 85.7% of the isolates. In addition, terbinafine was identified as the best antifungal for both Aspergillus and Candida species. Moreover, tested azoles had relatively low MICs, whereas most of the isolates had the MIC values beyond the caspofungin ECVs.
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Affiliation(s)
- Maral Gharaghani
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Halvaeezadeh
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Simin Taghipour
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Kiasat
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Zarei Mahmoudabadi
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Xu S, Li J, Ding L, Gao K, Xie F, Han J, Zhou X. Efficacy and safety of terbinafine hydrochloride spray and 3% boric acid alcohol ear drops in otomycosis. Acta Otolaryngol 2020; 140:302-306. [PMID: 32022618 DOI: 10.1080/00016489.2020.1712474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Although otomycosis is a disease spread throughout the world, there are only a few of studies about it.Objective: We aimed to evaluate the clinical efficacy of terbinafine hydrochloride spray (THS) in combination with 3% boric acid alcohol (3% BAA) ear drops compared to 3% BAA ear drops in otomycosis.Methods: This was a randomised, parallel-group, double-blind study involving 320 patients of both sexes aged 18 years or older.Results: The clinical cure rate was higher (p = .01) with THS in combination with 3% BAA ear drops than with 3% BAA ear drops alone. The change of mean total symptom score was significant with THS in combination with 3% BAA ear drops (p = .035). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving THS in combination with 3% BAA ear drops and those receiving only 3% BAA ear drops. Resolution rates of pruritus, otorrhea, aural fullness, tinnitus and hypoacusis (p = .005, p = .004, p = .002, p = .001, p = .004, respectively) was higher with THS in combination with 3% BAA ear drops, as was eradication (p = .001). There were seven mild adverse events, three with the THS in combination with 3% BAA ear drops (not related to the treatment) and four when 3% BAA was administered alone (not related to the treatment).Conclusions: THS in combination with 3% BAA ear drops is a more effective treatment for otomycosis than 3% BAA ear drops alone. The THS in combination with 3% BAA ear drops also has an excellent safety profile.Significance: To provides a safe and effective method for treating otomycosis.
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Affiliation(s)
- Shuai Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Jianfeng Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Ling Ding
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Kun Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Fengyang Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Jie Han
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Xuanchen Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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Görür K, İsmi O, Özcan C, Vayısoğlu Y. Treatment of Otomycosis in Ears with Tympanic Membrane Perforation is Easier with Paper Patch. Turk Arch Otorhinolaryngol 2020; 57:182-186. [PMID: 32128515 DOI: 10.5152/tao.2019.4384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the effectiveness of paper patch closure of tympanic membrane perforation in patients with otomycosis and tympanic membrane perforation. Methods Fifty-six otomycosis patients with central tympanic membrane perforations were included in the study. Patients were randomized into two groups as patched (PG) and non-patched (NPG) groups. In both groups, Castellani's solution was applied to the external auditory canal. In PG patients, the perforated tympanic membrane was covered with carbon paper patch soaked in Castellani's solution to reduce ear canal humidity and to prevent fungi from passing from the ear canal to the middle ear mucosa. Paper patch was not used in NPG patients. Results There were statistically significant differences between the two groups in terms of severity scores in the first, second, third, fourth and sixth weeks of admission (p=0.004, p=0.018, p=0.001, p=0.009, and p<0.001, respectively). Time to complete recovery was statistically shorter in PG patients (p<0.001). Disease recurrence was statistically less among PG patients compared to NPG patients (p=0.025). Conclusion Closing of perforation with paper patch and topical application of Castellani's solution was found to be an effective and safe method. The method eliminated otomycosis in a shorter period and reduced recurrence rate in patients with eardrum perforation.
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Affiliation(s)
- Kemal Görür
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Onur İsmi
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Cengiz Özcan
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
| | - Yusuf Vayısoğlu
- Department of Otorhinolaryngology, Mersin University School of Medicine, Mersin, Turkey
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Li Y, He L. Diagnosis and treatment of otomycosis in southern China. Mycoses 2019; 62:1064-1068. [PMID: 31368588 DOI: 10.1111/myc.12979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
Abstract
To analyse and discuss the clinical features and pathogenic characteristics, diagnosis and treatment of patients with otomycosis in southern China. Two hundred fifty-six patients from southern China diagnosed with otomycosis were randomly separated into two groups: the drug filling group and drug smearing group. Patients in the drug filling group were first examined and then had the pathogenic secretions in their external auditory canals cleared by otoendoscopy. Then, the local antifungal cream triamcinolone acetonide clotrimazole was injected into the external auditory canal. The same treatment was undertaken 1 week later and repeated once or twice more. Patients in the drug smearing group were also treated by otoendoscopy. Then, they were told to smear their external auditory canals once per day with the antifungal cream. All cases were followed for more than 6 months after the 3- to 4-week treatment. The main symptoms and otoendoscopic examination were used to evaluate the prognosis. Aspergillus was the commonest fungus. The cure rate was 93% in the drug filling group and 81% in the drug smearing group. Otomycosis is very common in southern China, but it lacks characteristic features in its early stages. Once diagnosed, the local lesions in the external auditory canal should be cleared thoroughly using otoendoscopy, and then, the local antifungal cream is injected into external auditory canal. The cure rate can be significantly improved with the foregoing treatment.
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Affiliation(s)
- Yongqi Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lifeng He
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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26
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Wimmer‐Scherr CM, Evrard L, Amory H, Cesarini C. Ulcerative lesion of the external ear canal causing headshaking in a horse. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Laurence Evrard
- Pôle EquinUniversité de LiègeFaculté de Médecine VétérinaireLiègeBelgium
| | - Hélène Amory
- Pôle EquinUniversité de LiègeFaculté de Médecine VétérinaireLiègeBelgium
| | - Carla Cesarini
- Pôle EquinUniversité de LiègeFaculté de Médecine VétérinaireLiègeBelgium
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Yang TH, Young YH. Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation. Audiol Neurootol 2019; 24:183-190. [PMID: 31454819 DOI: 10.1159/000501540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. OBJECTIVES The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. METHODS Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. RESULTS All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. CONCLUSION The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.
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Affiliation(s)
- Ting-Hua Yang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ho Young
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan,
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Koltsidopoulos P, Skoulakis C. Otomycosis With Tympanic Membrane Perforation: A Review of the Literature. EAR, NOSE & THROAT JOURNAL 2019; 99:518-521. [PMID: 31142158 DOI: 10.1177/0145561319851499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with otomycosis and to discuss the literature regarding the difficulties in managing this condition. DATA SOURCES Literature review from 1999 to 2019, Web of Science, PubMed, and Medline. STUDY SELECTION We searched for eligible articles concerning the clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of articles included for this review. DATA EXTRACTION All the articles described in the study selection were used for this review. DATA SYNTHESIS Statistical techniques were not used. CONCLUSION Based on the available literature, it seems that tympanic membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.
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Korkmaz S, Ceylan ME, Ceylan G, Dalgıç A, İnan S, Olgun L, Özüer MZ. Auditory and Histopathological Effects of Topical Mercurochrome Treatment in Rats with Tympanic Membrane Perforation. J Int Adv Otol 2018; 15:22-27. [PMID: 30541727 DOI: 10.5152/iao.2018.5489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Topical treatment is first choice in the treatment of uncomplicated chronic otitis media. It was intended to assess auditory and histopathological safety of ototopical use of mercurochrome solution in rats with induced tympanic membrane perforation. MATERIALS AND METHODS The study was conducted on 21 female Wistar-Albino rats which were randomly assigned into 3 groups. In all rats, perforation was performed at right tympanic membrane. Distortion product otoacoustic emissions (DPOAEs) measurements were performed at frequencies of 2000, 3000 and 4000 Hz (with L1/L2: 70 /70 dB at 2f1-f2 frequency; f2/f1 ratio: 1:22) before recovery from anesthesia and signal-to-noise ratio (SNR) were recorded. Normal saline, 2% mercurochrome and gentamicin were given to group 1, 2 and 3 twice daily over a week, respectively. Rats were sacrificed after DPOAE measurements on day 14. Right temporal bone specimens were examined under light microscope after processing. RESULTS Based on DPOAE results, there was no significant difference among groups before treatment. On day 14, significant differences were found in DPOAE measurements at 3000 and 4000 Hz, and in mean SNR values in 2% mercurochrome and gentamicin groups when compared to normal saline group while no significant difference was detected at 2000 Hz among groups. In addition, significant degeneration was detected in Corti organs, spiral ganglions and stria vascularis in groups 2 and 3. CONCLUSION In this study, it was observed that mercurochrome use in external otitis and otitis media with tympanic membrane perforation could cause ototoxicity and concluded that the solution should be used cautiously.
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Affiliation(s)
- Süleyman Korkmaz
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Emrah Ceylan
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Gözde Ceylan
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Abdullah Dalgıç
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Sevinç İnan
- Department of Histology and Embryology, İzmir Economy University School of Medicine, İzmir, Turkey
| | - Levent Olgun
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Ziya Özüer
- Department of Otorhinolaryngology, Health Sciences University, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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Dundar R, İynen İ. Single Dose Topical Application of Clotrimazole for the Treatment of Otomycosis: Is This Enough? J Audiol Otol 2018; 23:15-19. [PMID: 30518195 PMCID: PMC6348305 DOI: 10.7874/jao.2018.00276] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/14/2018] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives To determine the efficacy of filling the external auditory meatus with 1% clotrimazole at a single visit for the treatment of otomycosis. Subjects and Methods This prospective study included 40 patients who were referred to our clinic with complaints of ear itching, pain, and fullness, and were diagnosed with unilateral otomycosis. After cleaning the mycotic hyphae from the external auditory meatus, the ear canal was filled with 1% clotrimazole, using an intravenous catheter and syringe. The patients received follow-up examinations on post-treatment days 7, 15, and 45. Results The follow-up otomicroscopic examinations revealed that 95% of the ear canals were entirely clean and that all symptoms had resolved. The post-treatment scores of pain, aural fullness and itching were significantly lower than the pre-treatment scores (p<0.01). Conclusions Filling the external auditory meatus with 1% clotrimazole at a single visit is an easy, efficient, and cost-effective treatment for otomycosis. Additionally, high patient compliance makes this treatment superior to long-term topical therapy.
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Affiliation(s)
- Rıza Dundar
- Department of Otorhinolaryngology, Vocational School of Health Scienses, Acıbadem Mehmet Ali Aydınlar University, Eskis¸ ehir Hospital, Eskis¸ ehir, Turkey
| | - İsmail İynen
- Department of Otorhinolaryngology, Harran University, S¸ anlıurfa, Turkey
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Ali K, Hamed MA, Hassan H, Esmail A, Sheneef A. Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience. Int Arch Otorhinolaryngol 2018; 22:400-403. [PMID: 30357045 PMCID: PMC6197964 DOI: 10.1055/s-0038-1626702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/17/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.
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Affiliation(s)
- Khaled Ali
- Department of Otorhinolaryngology, Sohag University Faculty of Medicine, Sohag, Egypt
| | - Mahmood A. Hamed
- Department of Otorhinolaryngology, Sohag University Faculty of Medicine, Sohag, Egypt
| | - Hameda Hassan
- Department of Medical Microbiology and Immunology, Sohag University Faculty of Medicine, Sohag, Egypt
| | - Amira Esmail
- Department of Medical Microbiology and Immunology, Sohag University Faculty of Medicine, Sohag, Egypt
| | - Abeer Sheneef
- Department of Medical Microbiology and Immunology, Sohag University Faculty of Medicine, Sohag, Egypt
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Mahdavi Omran S, Yousefzade Z, Khafri S, Taghizadeh-Armaki M, Kiakojuri K. Effect of combination therapy with ceftizoxime and clotrimazole in the treatment of otomycosis. Curr Med Mycol 2018; 4:18-23. [PMID: 30186989 PMCID: PMC6101155 DOI: 10.18502/cmm.4.1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: There are controversial findings regarding the efficacy of antifungal drugs in the treatment of a ruptured eardrum following fungal infections. Regarding this, the aim of the present study was to evaluate the therapeutic effect of the co-administration of antifungal and antibacterial agents in the treatment of otomycosis with tympanic membrane perforation. Materials and Methods: This analytical, clinical trial was conducted on 87 patients with otomycosis showing no bacterial elements in the direct observation and culture. The study population was assigned into two groups of intervention (n=45) and control (n=42). The demographic and clinical data, as well as the data related to the direct observation and culture of the ear samples were recorded in a checklist. All statistical analysis was performed in SPSS (version 24). Results: The most prevalent symptoms in both groups were hearing loss and itching, and the most common finding was secretion. Aspergillus and Candida were the most frequent fungi isolated from the samples. After the implementation of combination therapy, the intervention group demonstrated a significant decrease in symptoms and signs, compared to the control group (P=0.005). Conclusion: The findings of the present study indicated that the use combination therapy with ceftizoxime powder and clotrimazole ointment was effective the in treatment of the patients with tympanic membrane rupture showing no bacterial effects in direct examination and culture.
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Affiliation(s)
- Saeid Mahdavi Omran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Center, Department of Parasitology and Mycology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Department of Medical Parasitology and Mycology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Yousefzade
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Soraya Khafri
- Department of Biostatistics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mojtaba Taghizadeh-Armaki
- Infectious Diseases and Tropical Medicine Research Center, Health Research Center, Department of Parasitology and Mycology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.,Department of Medical Parasitology and Mycology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Keyvan Kiakojuri
- Department of Ear, Nose, and Throat, Faculty of Medicine, Roohani Hospital, Babol University of Medical Sciences, Babol, Iran
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Ahmed MR, Abou-Halawa AS, Hessam WF, Abdelkader DSA. A search for new otomycotic species and their sensitivity to different antifungals. Interv Med Appl Sci 2018; 10:145-149. [PMID: 30713753 PMCID: PMC6343575 DOI: 10.1556/1646.10.2018.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Otomycosis is a common ear problem in countries with hot and humid climate. Emergence of new fungal species is a possibility particularly in patients with chronic illness or who receives antibiotics either systemically or topically. Aim To identify the otomycotic species, which are responsible for developing the otomycosis. Methods A descriptive study was carried out in 63 patients who were clinically diagnosed with otomycosis. Swabs were taken from the fungal debris to identify the causative agent and to determine the effective antifungals against it. Results Aspergillus species were the most common agents and were found in 47 patients (74.6%), represented by A. fumigatus (36.5%), A. niger (27%), A. flavus (6.5%), and A. terreus (4.8%). Ketoconazole (90%) and miconazole (76%) were the most effective antifungals against the species obtained from cultures, whereas fluconazole was the least effective. Conclusions Although there is no change in the mycology of otomycosis, there is still a significant variability in the isolated species and in their sensitivity to antifungal drugs. Ketoconazole exhibited broad spectrum effect against fungal isolates in this study, whereas fluconazole was the least efficacious.
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Affiliation(s)
- Mohammed Rifaat Ahmed
- Faculty of Medicine, Department of Otolaryngology, Suez Canal University, Ismailia, Egypt
| | | | - Waheed F Hessam
- Faculty of Medicine, Department of Microbiology and Immunology, Suez Canal University, Ismailia, Egypt
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de la Paz Cota BR, Cepero Vega PP, Matus Navarrete JJ, Aguado Mulgado GE, Narváez Huerta JJ, Lamadrid Bautista E, Fiscal Chauteco E. Efficacy and safety of eberconazole 1% otic solution compared to clotrimazole 1% solution in patients with otomycosis. Am J Otolaryngol 2018; 39:307-312. [PMID: 29551350 DOI: 10.1016/j.amjoto.2018.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/04/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To demonstrate non-inferiority of eberconazole 1% otic solution to clotrimazole 1% solution, and to compare their safety profiles in the treatment of otomycosis. MATERIALS AND METHODS Multicenter, randomized, double-blind, active treatment-controlled phase 3 clinical trial. One hundred and ninety patients with diagnosis of otomycosis were randomly assigned to eberconazole 1% otic solution or clotrimazole 1% solution. RESULTS Baseline characteristics were comparable between both groups for age, gender, ethnicity, and clinical variables. Both study groups had high complete response rates: 81.8% in the eberconazole group and 83.5% in the clotrimazole group. Although non-inferiority of eberconazole relative to clotrimazole could not be demonstrated, a post-hoc sensitivity analysis demonstrated that eberconazole 1% otic solution was not inferior to clotrimazole 1% solution for the primary efficacy endpoint. Secondary endpoints also demonstrated that eberconazole 1% and clotrimazole 1% solutions were therapeutically similar at the end of the study. The incidence of adverse events was similar in both groups, and none had related AEs and withdrawals due to an AE. CONCLUSIONS Eberconazole 1% otic solution is an efficacious and safe option to treat otomycosis-affected patients in the general practice.
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Fungal Suppurative Otitis Media (Histopathology) Among Patients in North India. Head Neck Pathol 2018; 13:149-153. [PMID: 29671212 PMCID: PMC6513980 DOI: 10.1007/s12105-018-0918-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
Chronic suppurative otitis media (CSOM) has a substantial worldwide prevalence and is a major cause of hearing impairment. In cases of CSOM unresponsive to local antibiotics, superimposed fungal infection should be suspected. The aim of the present study was to study the spectrum of cases with fungal otitis media. The study was conducted over a period of 12 years (2006-2017). Fifteen cases of CSOM clinically not suspected to be of fungal etiology that underwent surgery with identification of fungal organisms on histopathology were included in the study. Age of the patients ranged from 12 to 75 years (mean age: 37.1 ± 22.7 years). Of 15 cases, 9 (60.0%) were males and 6 (40.0%) were females. It was a unilateral presentation in all. The complaints observed were ear discharge in all followed by itching (86.7%), pain (46.7%), decreased hearing (26.7%) and blocking sensation (13.3%). Histomorphologic typing of fungus was possible in 13/15 patients. Isolated aspergillus was identified in eight patients while mucor alone was seen in three patients. Mixed infection with Aspergillus + Candida and Aspergillus + Mucor was seen in one patient each. Categorization of fungus could not be done in rest of the two patients due to paucity of fungal profiles. Histopathological identification of fungal organisms in otomycosis provides a quick and fairly reliable diagnosis. Culture is considered the gold standard but it may not always be available or fruitful. Less turnaround time and accurate diagnosis facilitates prompt and optimal therapy in fungal otitis media thus preventing adverse outcomes.
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Chappe M, Vrignaud S, de Gentile L, Legrand G, Lagarce F, Le Govic Y. Successful treatment of a recurrent Aspergillus niger otomycosis with local application of voriconazole. J Mycol Med 2018; 28:396-398. [PMID: 29673769 DOI: 10.1016/j.mycmed.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
Fungal otitis (otomycosis) is a common infection encountered by otolaryngologists. Nevertheless, its management can be challenging because of its high recurrence rate and of the limited therapeutic options. A 45-year-old woman suffered from recurrent otomycosis. The ineffectiveness of successive antibiotic cures and repeated topical treatments with nystatin and then with econazole cream led to perform microbiological analyses. Culture of ear swab grew Aspergillus niger. The use of a 1% voriconazole sterile solution previously validated for treatment of eye infections was considered after ensuring the absence of known ototoxic effects of the antifungal and of the excipients. The patient was advised to apply locally this voriconazole solution daily for 14 days (3 drops, 3-4 times a day). Full recovery was obtained at the end of the treatment, and no relevant side effects were noticed. More than one year after completion of therapy, there was no recurrence. Our observation shows that voriconazole 1% solution is an interesting option for treating otomycosis which failed to respond to usual therapeutic options. Further prospective studies are now warranted to confirm these findings.
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Affiliation(s)
- M Chappe
- Pharmacie Centrale, CHU d'Angers, 49933 Angers, France
| | - S Vrignaud
- Pharmacie Centrale, CHU d'Angers, 49933 Angers, France.
| | - L de Gentile
- Laboratoire de parasitologie-mycologie, CHU d'Angers, 49933 Angers, France
| | - G Legrand
- Cabinet d'otorhinolaryngologie, clinique de l'Anjou, 49000 Angers, France
| | - F Lagarce
- Pharmacie Centrale, CHU d'Angers, 49933 Angers, France; Inserm U1066, CNRS 6021, micro- et nanomédecines biomimétiques, université Bretagne-Loire, 49933 Angers, France
| | - Y Le Govic
- Laboratoire de parasitologie-mycologie, CHU d'Angers, 49933 Angers, France; Groupe d'étude des interactions Hôte-Pathogène, EA 3142, université Bretagne-Loire, 499333 Angers, France
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Kamali Sarwestani Z, Hashemi SJ, Rezaie S, Gerami Shoar M, Mahmoudi S, Elahi M, Bahardoost M, Tajdini A, Abutalebian S, Daie Ghazvini R. Species identification and in vitro antifungal susceptibility testing of Aspergillus section Nigri strains isolated from otomycosis patients. J Mycol Med 2018. [PMID: 29540288 DOI: 10.1016/j.mycmed.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Aspergillus niger is the most commonly reported etiology of otomycosis based on morphological characteristics. This fungus is a member of Aspergillus section Nigri, a set of morphologically indistinguishable species that can harbor various antifungal susceptibility patterns. The aim of this study was to accurately identify and determine the susceptibility pattern of a set of black aspergilli isolated from otomycosis patients. METHODS Forty-three black Aspergillus isolates from otomycosis patients were identified by using the PCR-sequencing of the β-tubulin gene. Furthermore, the susceptibility of isolates to three antifungal drugs, including fluconazole (FLU), clotrimazole (CLT) and nystatin (NS), were tested according to CLSI M38-A2. The data were analyzed using the SPSS software (version 15). RESULTS The majority of isolates were identified as A. tubingensis (32/43, 74.42%) followed by A. niger (11/43, 25.58%). The lowest minimum inhibitory concentration (MIC) values were observed for NS with geometric means (GM) of 4.65μg/mL and 4.83μg/mL against A. tubingensis and A. niger isolates, respectively. CLT showed wide MIC ranges and a statistically significant inter-species difference was observed between A. tubingensis and A. niger isolates (P<0.05). FLU was inactive against both species with GMs>64μg/mL. CONCLUSION Species other than A. niger can be more frequent as observed in our study. In addition, considering the low and variable activity of tested antifungal drugs, empirical treatment can result in treatment failure. Accurate identification and antifungal susceptibility testing of isolates is, however, recommended.
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Affiliation(s)
- Z Kamali Sarwestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran
| | - S J Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran
| | - S Rezaie
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran
| | - M Gerami Shoar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran
| | - S Mahmoudi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Elahi
- Department of Head and Neck surgery, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Bahardoost
- Colorectal research center, Iran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - A Tajdini
- Department of Head and Neck surgery, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Abutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - R Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Pour Sina st., Keshavarz Blvd., Tehran, Iran.
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Woods O, Saliba I. Locacorten Vioform Ototoxicity Upon Guinea Pig Middle Ear Application. J Audiol Otol 2018; 22:75-79. [PMID: 29301391 PMCID: PMC5894488 DOI: 10.7874/jao.2017.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives Locacorten Vioform (Novartis UK) is frequently prescribed for otomycosis. Its component, Clioquinol, also has anti-bacterial properties. Up to this point, its ototoxic potential has not been evaluated. Our objective aims to evaluate Locacorten Vioform’s potential ototoxicity when applied directly to the middle ear cavity. Materials and Methods We performed an experimental prospective animal study in our animal research center with 20 Hartley guinea pigs divided into 2 groups. The first group (experimental) was treated with Locacorten Vioform in one ear and with a physiologic saline solution in the other. The second group (positive control) was treated with concentrated gentamycin in one ear and physiologic saline in the other. Auditory brainstem response measurements were obtained before and after three sets of injections. Statistics were analyzed using a variance analysis with repeated measures. The histological state of cochlear outer hair cells was compared between the two groups using scanning electron microscopy. Results Average hearing loss in ears treated with Locacorten Vioform was 32.1 dB, compared with a 2.5 dB average loss in the saline-treated ears. Ears treated with gentamycin lost an average of 33.0 dB. There were clinically and statistically significant differences between the two ears of the guinea pigs in both groups (p<0.001). Scanning electron microscopy revealed severe pericochlear and cochlear inflammation and ossification in the Locacorten Vioform-treated ears. Gentamycin caused significant destruction of outer hair cell architecture. Conclusions Locacorten Vioform induces a hearing loss similar to that caused by gentamycin when applied directly to the middle ear of a guinea pig model. Electron microscopy indicates a pericochlear and cochlear inflammatory reaction with ossification.
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Affiliation(s)
- Owen Woods
- Division of Otolaryngology-Head and Neck Surgery, Sainte-Justine University Hospital Center, University of Montreal, Montreal, CanadaM
| | - Issam Saliba
- Division of Otolaryngology-Head and Neck Surgery, Sainte-Justine University Hospital Center, University of Montreal, Montreal, CanadaM
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Ameye SA, Adeyemo A, Eziyi JA, Amusa YB. Clinical Profile of Otomycosis in a Sub-saharan African Tertiary Health Center. ACTA ACUST UNITED AC 2018. [DOI: 10.5005/jp-journals-10003-1290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Swain SK, Behera IC, Sahu MC, Das A. Povidone iodine soaked gelfoam for the treatment of recalcitrant otomycosis - Our experiences at a tertiary care teaching hospital of eastern India. J Mycol Med 2017; 28:122-127. [PMID: 29223643 DOI: 10.1016/j.mycmed.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Otomycosis is a common clinical condition seen in outpatient department of otorhinolaryngology. The treatment of the otomycosis is also very simple. However, sometime it is difficult to treat otomycosis along with mastoid cavity, chronic suppurative otitis media, immunocompromised patient, etc. with conventional treatment, called recalcitrant otomycosis. Here, we describe a technique of treatment for recalcitrant otomycosis. MATERIALS AND METHODS This is a prospective observational study/clinical trial carried out on 44 patients of recalcitrant otomycosis. They are divided into two groups, each of 22. One group treated with routine clotrimazole topical eardrops whereas other group treated with povidone iodine soaked gelfoam, placed in the external auditory canal. RESULTS There was no significance difference according to the age (P=0.134), gender (P=0.760) and causative agents (P=0.750) between treatment groups. The resolution of the symptoms showed statistically significant on itching (P=0.0001), otorrhoea (P=0.0033), fullness (P=0.0432) and earache (P=0.0259), whereas no statistical significant on hearing loss (P=0.0683), when treating with povidone iodine soaked gelfoam as compared to routine (clotrimazole) treatment. Resolution of signs like canal wall erythema (P=0.0045), tragal tenderness (P=0.0012) and congestion of tympanic membrane (P=0.0088) is statistically significant when comparing clotrimazole with povidone iodine. Apart from these, we did not reveal any adverse effects from the study populations treated with povidone iodine soaked gelfoam. CONCLUSION Use of the povidone iodine soaked gelfoam at the external auditory canal in recalcitrant otomycosis is an effective and well-tolerated treatment.
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Affiliation(s)
- S K Swain
- Department of otorhinolaryngology, IMS and SUM hospital, Siksha "O" Anusandhan university, K8, Kalinganagar, 751003 Bhubaneswar, Odisha, India.
| | - I C Behera
- Department of community medicine, IMS and SUM hospital, Siksha "O" Anusandhan university, K8, Kalinganagar, 751003 Bhubaneswar, Odisha, India
| | - M C Sahu
- Directorate of medical research, IMS and SUM hospital, Siksha "O" Anusandhan university, K8, Kalinganagar, 751003 Bhubaneswar, Odisha, India
| | - A Das
- Department of otorhinolaryngology, IMS and SUM hospital, Siksha "O" Anusandhan university, K8, Kalinganagar, 751003 Bhubaneswar, Odisha, India
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Ismail MT, Al-Kafri A, Ismail M. Otomycosis in Damascus, Syria: Etiology and clinical features. Curr Med Mycol 2017; 3:27-30. [PMID: 29707671 PMCID: PMC5914924 DOI: 10.29252/cmm.3.3.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose: Otomycosis is a fungal infection that frequently involves the external auditory canal. The epidemiologic data on the etiologic agents of otomycosis in Syria are very limited. In this study, we aimed to determine the fungal agents, gender distribution, and clinical presentation of otomycosis. Materials and Methods: Two hundred and ninety nine patients (153 [51.17%] male and 146 [48.83%] female) clinically prediagnosed as otomycosis were studied at Al-mouassat University Hospital and ENT Crescent Syrian Clinic. Clinical samples were collected from the ear discharges and cultured on Sabouraud Agar. Results: Otomycosis was diagnosed in 70 (23.4%) cases, with the highest prevalence in males aged 16-75 years (73.6%). The isolation rates of mold and yeast fungi were 75.7% and 24.3%, respectively. The most common presentations were otorrhea (98.66%), otalgia (18.06%), and hearing loss (6.35%). Our results showed that 64.28% of otomycosis agents were Aspergillus species. A.niger was the most common agent (45.7%), and 24.3% of the pathogens were C.albicans. Conclusion: Otomycosis agents most commonly belonged to the genus of Aspergillus followed by Candida, which should be seriously considered by physicians for appropriate treatment.
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Affiliation(s)
- Mohammad T Ismail
- Department of Microbiology, Faculty of Pharmacy, Arab International University (AIU), Ghabaghib, Daraa Governorate, Syria
| | - Abeer Al-Kafri
- Department of Microbiology, Faculty of Pharmacy, Arab International University (AIU), Ghabaghib, Daraa Governorate, Syria
| | - Mazen Ismail
- Research Department, Arab International University (AIU), Ghabaghib, Daraa Governorate, Syria
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Kirschner R, Sun PL, Huang SL, Chen CL, Yang CP. A case of bilateral otomycosis associated with Aspergillus flavus and A. terreus in Taiwan. J Mycol Med 2017; 27:412-416. [PMID: 28501466 DOI: 10.1016/j.mycmed.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
Otitis externa caused by fungi (otomycosis) occurs more commonly in tropical areas with high moisture than in temperate regions. Bilateral otomycosis is, however, rarely reported. In a case of bilateral otitis externa in a 56-year-old male patient in Taiwan, direct microscopic examination of the cerumen as well as isolation of strains indicated the presence of two Aspergillus species being different in each of both ears. The species were identified by DNA sequence comparisons and additional morphological confirmation of diagnostic characteristics as Aspergillus flavus and Aspergillus terreus. The rarely reported occurrence of two Aspergillus species in otitis of the same patient deserves attention in other cases of otomycosis, particularly with respect to potentially different resistances of different species against antifungals. Treatment with nystatin/neomycin was not successful, but with clotrimazole was effective.
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Affiliation(s)
- R Kirschner
- Department of life sciences, National Central university, Zhongda Rd. 300, Zhongli District, 320, Taoyuan City, Taiwan.
| | - P-L Sun
- Department of dermatology, Chang Gung Memorial hospital, Linkou, Taoyuan, Taiwan; College of medicine, Chang Gung university, Taoyuan, Taiwan.
| | - S-L Huang
- Institute of microbiology and immunology, National Yang Ming university, Taipei, Taiwan.
| | - C-L Chen
- Division of nephrology, department of medicine, Taiwan Landseed hospital, Taoyuan, Taiwan.
| | - C-P Yang
- Chunghwa chemical synthesis & biotech company, 23850 New Taipei City, Taiwan.
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Mofatteh MR, Naseripour Yazdi Z, Yousefi M, Namaei MH. Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment. Braz J Otorhinolaryngol 2017; 84:404-409. [PMID: 28549873 PMCID: PMC9449227 DOI: 10.1016/j.bjorl.2017.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Otomycosis is a common diseases that can be associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be challenging, and requires a close follow-up. Treatment options for otomycosis include local debridement, local and systemic antifungal agents and utilization of topical antiseptics. Objective This study was designed to compare the recovery rate of otomycosis using two therapeutic methods; topical betadine (Povidone-iodine) and clotrimazole. Methods In this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p < 0.05. Results The results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole showed a good clinical response to treatment (p = 0.75). A good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p = 0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p = 0.46) in the groups treated with betadine and clotrimazole, respectively. The response to treatment was thus not significantly different in the two groups. Conclusion In the present study the efficacy of betadine and clotrimazole was the same for the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in otomycosis treatment, helping to avoid the emergence of resistant organisms.
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Affiliation(s)
- Mohammad Reza Mofatteh
- Birjand University of Medical Science, School of Medicine, Department of Ears, Nose and Throat, Birjand, Iran
| | | | - Masoud Yousefi
- Birjand University of Medical Science, Infectious Diseases Research Center, Birjand, Iran
| | - Mohammad Hasan Namaei
- Birjand University of Medical Science, Infectious Diseases Research Center, Birjand, Iran.
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Otomycosis in Western Iran: Clinical and Mycological Aspects. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.57287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effectiveness of 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in otomycosis patients: a randomised, controlled trial. J Laryngol Otol 2016; 130:811-5. [PMID: 27477534 DOI: 10.1017/s0022215116008598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare the clinical effectiveness and adverse events for 3 per cent boric acid in 70 per cent alcohol versus 1 per cent clotrimazole solution in the treatment of otomycosis. METHODS A total of 120 otomycosis patients were randomly assigned to receive either 1 per cent clotrimazole solution (intervention group) or 3 per cent boric acid in 70 per cent alcohol (control group) at the Khon Kaen Hospital ENT out-patient department. Treatment effectiveness was determined based on the otomicroscopic absence of fungus one week after therapy, following a single application of treatment. RESULTS After 1 week of treatment, there were data for 109 participants, 54 in the clotrimazole group and 55 in the boric acid group. The absolute difference in cure rates between 1 per cent clotrimazole solution and 3 per cent boric acid in 70 per cent alcohol was 17.9 per cent (95 per cent confidence interval, 2.3 to 33.5; p = 0.028) and the number needed to treat was 6 (95 per cent confidence interval, 3.0 to 43.4). Adverse events for the two agents were comparable. CONCLUSION One per cent clotrimazole solution is more effective than 3 per cent boric acid in 70 per cent alcohol for otomycosis treatment.
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1621] [Impact Index Per Article: 202.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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Song JE, Haberkamp TJ, Patel R, Redleaf MI. Fungal otitis externa as a cause of tympanic membrane perforation: a case series. EAR, NOSE & THROAT JOURNAL 2016; 93:332-6. [PMID: 25181663 DOI: 10.1177/014556131409300811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.
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Affiliation(s)
- James Eingun Song
- Department of Dermatology, University of California, Irvine, 118 Med Surge I, Irvine, CA 92697, USA.
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Lam PL, Lee KKH, Kok SHL, Gambari R, Lam KH, Ho CL, Ma X, Lo YH, Wong WY, Dong QC, Bian ZX, Chui CH. Antifungal study of substituted 4-pyridylmethylene-4′-aniline Schiff bases. RSC Adv 2016. [DOI: 10.1039/c6ra20186e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Two substituted 4-pyridylmethylene-4′-aniline Schiff bases showed antifungal activity against.Aspergillus nigerandCandida albicans. They may be useful for the development of safe drug candidates forA. nigerandC. albicanscases of otomycosis.
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Goodale EC, Outerbridge CA, White SD. Aspergillusotitis in small animals - a retrospective study of 17 cases. Vet Dermatol 2015; 27:3-e2. [DOI: 10.1111/vde.12283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Elizabeth C. Goodale
- William R. Pritchard Veterinary Medical Teaching Hospital; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Catherine A. Outerbridge
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
| | - Stephen D. White
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California - Davis; 1 Garrod Drive Davis CA 95616 USA
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