AB091. 239. Treatment of otomycosis: a review

Background: The incidence of fungal otitis externa in western Europe, has increased over the past number of decades. Clinically, it presents in a similar fashion to other pathologies, therefore, it can be often be misdiagnosed and treated inappropriately. Aspergillus and Candida are shown to be the commonest causative species isolated in fungal otitis externa. Otomycosis is commonly diagnosed post antimicrobial therapy with no resolution. To date, there is no gold standard approach in place for the treatment of otomycosis. Several studies have shown the efficacy of topical drying agents, anti-inflammatories, antifungals, and combination powders as part of a multi-modal approach. To identify the different approaches and modalities used for the eradication of fungal otitis externa.

Methods: Review of the literature surrounding the management and treatment of otomycosis.

Results: Topical antifungals are effective in the eradication of Aspergillus and Candida. Clotrimazole as a monotherapy has been found to have the greatest efficacy. Combination powders are effective in eradicating otomycosis, while also providing additional coverage against other offending pathogens. Studies show that multimodal approaches have the most promising end results.

Conclusions: Ototopical antifungals are effective in the eradication of otomycosis, with clotrimazole shown to be the most effective. However, a multi-modal approach such as microsuction and insufflation of a combination powder has an increased likelihood of fungal eradication with additional antimicrobial cover.

Keywords: Otomycosis; antifungal; azole; combination powder; mastoid powder