DOI: 10.14260/jemds/2014/3462

ORIGINAL ARTICLE

OTOMYCOSIS: AN OVERVIEW IN HYDERABAD KARNATAKA REGION

R. B. Chapparbandi1, FarhaNaaz Kazi2, Kazim Ali3

HOW TO CITE THIS ARTICLE:

R. B. Chapparbandi, FarhaNaazKazi, Kazim Ali.“Otomycosis: An Overview in Hyderabad Karnataka Region”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 46, September22; Page: 11213-11216,

DOI: 10.14260/jemds/2014/3462

ABSTRACT: OtomycosisisacommonclinicalprobleminHyderabadKarnatakaregionbecauseofthehot,humidclimateofthisregion.Theinfectioncanbediagnosedclinicallyonthebasisofsymptomslikeitching,otalgia,discharge,blockage,hearinglossandpresenceofdebrisresemblingwetblottingpaperappearanceintheexternalauditorymeatus.Itiscommoninmalesandoccursmoreinthe21-30yearagerange.Themostcommonsymptomsinourreviewwereitchingfollowedbyhearingloss,otorrhoeaandblockage.Otomycosiswaspredominantlyunilateralwithleftearaffectedmore.ThespeciesoffunguscausingthediseaseinourcenterisAspergillusNiger.Drugslikeclotrimazole/lidocaine,aceticacidhydrochloride(eardrops)orGentianvioletareindispensibletopicalagentsinthemanagementofotomycosis.Gentianvioletshouldonlybeusedastreatmentoflastresortbecauseitdiscolorstheexternalauditorycanalgivingapoorcosmeticappearanceduringtreatment.

KEYWORDS:otomycosis, clinical diagnosis,treatment.

INTRODUCTION: Otomycosisisgenerallydescribedinliteratureasfungalinfectionoftheexternalauditorycanal.Itcanbeassociatedwithchronicmiddleeardischargeandopenmastoidcavityinfection.Hundredormorespeciesoffungiareidentifiedaspathogenstilldate.ThecommonaetiologicalagentsincludetheAspergillusspecies;Afumigatus,ANigerandtheCandidaspecies;Candidaalbicans.Otherfungiinvolvedare,Penicillium,Pitirosporum.[1,2,3]

Otomycosishasaworldwidedistributionwithmoreprevalenceinwarm,wet,humidanddustyenvironments.Itsincidencehasincreasedduetoincreasinguseofantibiotics,immune suppressantandbadauralhygiene,instillinghotoilandwaterintheear.ThediseaseissaidtobecommoneronthosewhowearheadcoversinsomepartsoftheWorld.[5]Itisalsocommonamongswimmershencesometimescalled“swimmersear”.

Symptomsusuallyinclude:itching,otalgia,otorrhoea,earblockage,hearinglossandtinnitus.[9,10,11]Examinationusuallyrevealsthepresenceofdebrisrangingincolourfromwhitetoblackresembling“wetblottingpaper”intheexternalauditorymeatus.Diagnosisisusuallyclinicalwithmycologicstudiestoconfirmtheparticularspeciesofcausativefungi.Treatmentisbysuctionclearanceorauralsyringingfollowedbytopicalanti-fungalagents.Manyantifungalswereusedforotomycosiswithdifferentpercentageofsuccessbutstandardregimeisnotfirmlyestablished.

PATIENTS AND METHODS: ThisretrospectivestudywascarriedoutattheOtorhinolaryngology(ORL)departmentofourhospital.Thestudywascarriedouton159casesclinicallydiagnosedasmycoticotitisexternaattendingouroutpatientdepartment.

Clinicrecordsofpatientsseenwithinthisperiodwithahistoryofearcomplaintswerereviewedforage,sex,clinicalsymptoms,laterality,and durationofsymptoms,previousmedicationsandtreatmentgiven.Thediagnosisofotomycosiswasbasedonclinicalhistoryandotoscopicexamination.

Theclinicalsymptomsofitching,otalgia,earblockage,hearingloss,anddischargeintheearcanalwereregardedasclinicaldiagnosticofotomycosis.Afterclinicaldiagnosisismade,allcasesweresubjectedformycologicalexamination.Twosterileswabswerecollectedfromearcanalofeachpatient.OneswabwasculturedonSaboraud’smediumtowhichChloromycetinandactidolwereaddedtosuppressthegrowthofbacteria.

Theinoculatedplateswereculturedat37degreeCentigrade.Theotherswabwasusedfordirectmycologicalexaminationusing10%KOH.Treatmentwasbyoneoftwomethods;Patientswithsuspectedperforationofthetympanicmembranehadauraltoiletingorsuctionclearancefollowedbytopicalapplicationofantifungalagents.Thosewithintacttympanicmembraneshadauralsyringingfollowedbytopicalantifungalagents.Topicalantifungalagentsusedwereeither;clotrimazole/lidocainehydrochloride-(Candideardrops)orGentianviolet.

RESULTS: Intheperiodunderreview,159patientswerediagnosedasotomycosisintheoutpatientclinic.Earsymptomssuggestiveofotomycosiswere;Pruritus(93%),Otalgia(84%),Muskyeardischarge(73.5%),Blockage(79%),Hearingloss(50.3%),andTinnitus(39%).TableIIOfthe159patients,unilateralleftearwasaffectedin80(50.32%),unilateralrightearwasaffectedin69(43.39%),andbilateralaffectedis10patients(6.29%).TableIII

Treatmentwasrepeatedin35patientswhohadrecurrentinfection.Ofthese,27(77.1%)hadcurewhilesymptomspersistedin8(22.9%).ThepatientswerecommonlyaffectedbyAspergillusspecies.AspergillusNiger(55.97%),Aspergillusflavus(28.94%),Aspergillusfumigates(4.41%)followedbyCandidaspecies(1.25%)TableIV.

Age(inyears) / No.ofpatients / Percentage
0-10 / 25 / 15.72
11-20 / 42 / 26.42
21-30 / 45 / 28.30
31-40 / 19 / 11.95
41-50 / 13 / 8.18
51-60 / 09 / 5.66
61-70 / 04 / 2.52
71-80 / 02 / 1.25
Total / 159 / 100.0
TABLE I: Age distribution of patients (n=338)
Symptoms / No.ofcases / Percentage
Itchingintheear / 149 / 93.37
Pain / 135 / 84.90
Feelingofblocksensation / 126 / 79.25
Eardischarge / 117 / 73.59
Tinnitus / 63 / 39.62
Deafness / 55 / 34.60
Others / 2 / 1.25
TABLE II: Common signs and symptoms of otomycosis
Laterality / No.ofcases / Percentage
Left / 80 / 50.32
Right / 69 / 43.39
Bilateral / 10 / 6.29
Total / 159 / 100
TABLE III: Ear distribution of otomycosis
Fungalisolate / No.ofcases / Percentage
Aspergillusniger / 89 / 55.97
Aspergillusflavus / 46 / 28.94
Aspergillusfumigates / 07 / 4.41
Candidaalbican / 11 / 6.93
Candidaspecies / 02 / 1.25
Mucorspecies / 02 / 1.25
Penicillium / 02 / 1.25
Total / 159 / 100
TABLE IV: fungal isolates encountered in mycotic otitis externa

DISCUSSION: Otomycosisisacommonclinicalprobleminourregion.Thisisnotsurprisingbecauseofthehothumid,dustyclimateoftheregion.[1,4,5]AccordingtoPauloseetalotomycosisoccursmoreinthosewhowearheadcoversincertainpartsoftheworld.5Headcoversincreasemoistureandheatandhumidityaroundtheears.

Ourdiagnosisandtreatmentwaspresumptivebasedonclinicalsymptomsandsignsincludingpruritus,otalgia,blockagehearinglossandpresenceofdebrisresemblingwetnewspaperintheexternalauditorymeatus.Thisagreewithliteraturereportsthattheinfectioncanbediagnosedclinicallyonthebasisofsymptoms.[1,4,5]

OtomycosiswascommonerinmalesascomparedtostudybyM.M.Yehiaetalwhoreportedahigherincidenceinfemalesandmainlyinhousewives.[5]Inourstudy,thehighestnumberofcasesofotomycosisoccurredinthe21-30yearagerangesimilartothefindingsofRavindaKauretalinwhichotomycosiswasmoreprevalentbetweentheagesof16-30years.[1]Theseagegroupsdomoreswimmingandphysicalexerciseswhichpredisposedthemtootomycosis.

Inourreview,otomycosiswaspredominantlyunilateralwithleftearmoreaffected.Thisagreeswithmanystudiesreportingthatotomycosisisusuallyunilateral.[1,3,7]Themostcommonsymptomsinourreviewwerepruritusfollowedbypainandblockageduetodebris.Differentstudieshaveshownvariationsinthemostcommonsymptoms.Otalgiaandblockage,[1,4]discharge,[3]itching,[5]andotalgia.[8]

Ourstudyhighlightsthemostcommonfungicausingotomycosis.ThespeciesoffunguscausingthediseaseinoursettingisAspergillusNiger.Allthecasesrespondwelltotopicalantifungalagentslikeclotrimazole. Inconclusion,otomycosisisacommonprobleminHyderabadKarnatakaregionandthemostcommonetiologicalagentisAspergillusNiger.

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J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 46/Sep 22, 2014 Page 1