Abstract
ABSTRACT Otomycosis is increasing in prevalence and can account for up
to 20% of ENT outpatient consultations in warm and humid regions.
Objectives: The aim of this review was to investigate the treatment
strategies and antifungal agents used in various institutions and to
highlight current trends. Design: PubMed, Cochrane Library and Google
Scholar electronic databases were searched for freely-accessible
articles spanning January 2001 and December 2020. Results: 59 full-text
English-language articles were retrieved. Aspergillus spp. were the
commonest species isolated followed by Candida spp.
Clotrimazole-resistant Aspergillus spp. were encountered more frequently
among immunosuppressed patients. Topical medications included drops,
creams, ointments, powders, lotions and sprays. Systemic treatment was
given orally or intravenously. Antifungal agents used were azoles,
polyenes, echinocandin, allylamine, thiocarbamate, hydroxyquinoline and
griseofulvin. Antiseptics employed included Betadine, Gentian Violet,
N-chlorotaurine, Castellani’s Paint, Cresylate drops and Tincture
Merthiolate. Steroids (beclomethasone, betamethasone, dexamethasone and
hydrocortisone) were generally used in combination therapy. Acidifying
agents administered were 3% boric acid, 2% acetic acid and 2%
salicylic acid. Lignocaine and tetracaine formed part of some
formulations. Conclusions: Topical applications are the mainstay of
treatment of otomycosis, but occasionally oral or intravenous agents are
required. Aural toilet and specific antiseptics have an important role.
Clotrimazole remains an essential antifungal against a variety of fungi,
but other antifungals may be needed against resistant species and in
immunocompromised patients.