More and more often, patients with complaints of ear congestion, hearing loss and itching in the auditory canal are coming to the otolaryngologists. Thus, a fungal infection of the ear, called otomycosis, is manifested. And although the prognosis of the disease is favorable, the treatment presents certain difficulties, caused primarily by the choice of an effective antimycotic drug.
The causes of otomycosis
Otitis of fungal etiology is classified based on the localization of inflammation. External fungal otitis is diagnosed in 62% of cases, fungal otitis media in 20% of cases, fungal otitis media after surgery - in 17% of cases, fungal myringitis - in 1%.
As a causative agent of otomycosis, mold fungi Aspergillus (65%), Penicillium (10%) act. In 24% of cases, yeast-like Candida fungi are pathogens. It is possible and mixed infection, but all these types of pathogens cause otomycosis only under certain conditions. These conditions can be endogenous and exogenous.
Endogenous: somatic diseases, which inevitably cause general weakening of the body, hypovitaminosis, disturbance of metabolic processes.
Exogenous: local and systemic antibiotic therapy, the use of corticosteroids for a long time, cytostatics treatment, radiation therapy, ear trauma (for example, with improper cleaning of the external auditory canal), swimming in open water. Often there is a lesion of the postoperative cavity of the ear.
Symptoms
Symptoms directly depend on the stage of the disease.
At the stage of harbingers, there are no objective changes, the patient feels only stuffiness of the ear and itching. From the ear canal disappears fatty film, there is a puffiness. These symptoms are taken by most for the accumulation of sulfur and attempt to clear the auditory canal. The result is skin trauma and penetration of fungal infection.
The acute stage of mycosis is characterized by the presence of secretions from the auditory canal. The volume of secretions is constantly increasing, as, indeed, puffiness. It provokes the overlapping of the lumen of the auditory canal, because of which the hearing decreases. If you carefully study the selection, you can find in them mycelium and epidermis of fungi. Individual patients note the presence of hypersensitivity behind the ear. Usually, the infection is limited to the skin of the outer ear, but in diabetics it can spread into the middle ear cavity.
The main symptom of mycotic otitis media is specific secretions, the consistency and color of which depend on the nature of the fungus that causes otomycosis. This form differs from the previous hyperthermia of the tympanic membrane, there are also perforations of different sizes. Patients complain of increased pain and even greater hearing loss.
Another type of otomycosis is fungal myringitis. With this form, the lesion extends to the tympanic membrane.
Otomycosis of the postoperative cavity may occur after radical mastoidectomy or tympanoplasty. The reason - a long finding in the auditory passage of cotton swabs, impregnated with a solution of antibiotic and glucocosteroids. Clinically, the disease is manifested by increased pain in the behind-the-ear area, an increase in the amount of secretion from the ear.
Again, the symptomatology of otomycosis is insidious - it is similar to classical otitis, so if you suspect a fungal lesion, you should immediately go to a specialist and take a few smears - culture and microscopy. If a pseudomycelia spore is detected, the doctor will prescribe adequate therapy.
Treatment
Otomycosis therapy presents known difficulties, primarily because of inadequate drug efficacy and frequent relapses, high costs of antifungal agents.
With external fungal otitis, first use local antifungal drugs, and if they do not help, attach therapy with systemic drugs.
Fungal otitis media is immediately treated with systemic drugs. Local use only as an addition.
So, how and what to treat different forms of otomycosis?
Regardless of the form of the disease, precaution of local therapy is thorough ear cleaning. Its goal is to remove the pathological detachable, the remains of which, even in small amounts, often reduce the effectiveness of treatment and increase the duration of treatment. Only an expert does it, using a quilted pad, moistened with an anti-mycotic drug and an attic probe.
With an average otitis, special attention is paid to cleaning the eardrum that is separated from the perforation area. In the case of large perforations, removal of the discharge is combined with the washing of the drum cavity with miramistin (0, 01%, solution). Similarly come with otomycosis of the postoperative cavity. If there are polyps and granulations, they are removed or extinguished with nitric-silver (20%, solution).
External fungal otitis media
Ointments that have proven themselves in the treatment of other candidiasis and mycoses, with otomycosis are ineffective. First of all, because of the impossibility of applying an even layer on a narrow by nature external auditory canal. Therefore, the most convenient form of drugs are suspensions, solutions and emulsion formulations.
Apply them as follows: moisten the medicinal substance with cotton turuns (gauze swabs can injure the skin) and leave in the ear canal for 10-15 minutes (guided by the instruction). Manipulation is repeated 4-5 times a day.
Step therapy Exodaril :
1, 2, 3 days: twice a day 15-minute applications with Exoderyl solution
4, 5, 6, 7 day: twice daily cream Exoderyl
From 8 days for 3 weeks cream Exoderil 1 p. A day, and then 1 p. In 2 days 2 more weeks .
With this treatment, microbiological diagnosis is repeated on the 7th and 45th days of treatment.
In addition to Exodderil, treatment with such drugs as:
Candibiotics (drops) are contraindicated in the perforation of the tympanic membrane, in all other cases the drops give a quick analgesic result and reduce inflammatory phenomena on the skin of the auditory canal. Allowed during pregnancy and lactation. The only condition for use is short-term use and low doses.
Dosing: 3-4 times a day for 4-5 drops with the auditory meatus. The result is visible after 3-5 days, but treatment should be continued for 7-10 days.
In addition to antifungal therapy, the importance of treatment of concomitant diseases, the rejection of antibiotics, restorative treatment and vitamin therapy. In the event that otomycosis occurs in a child, antifungal treatment should be combined with taking drugs that restore the intestinal microbiocenosis (acipol, bifikol, hilak forte, linex, bactisubtil, lactobacterin, etc.).
If a low interferon status is detected, then substitution interferon therapy (viferon in the form of suppositories and megasins on an ointment basis) is performed.
Mycotic otitis media
The defeat of the middle ear is considered a more complicated case and requires "shock" dosages of antimycotics.
Systemic preparations:
- Nystatin - 3 000 000 units, course - two weeks, if necessary, a second course after a break of 10 days;
- Levorin - 2 000 000 units, duration is determined by the doctor;
- Amphoglucamine - 400 000 units, duration - 10 days;
- Mycoheptin - 5 000 000 units, duration - 10-14 days;
Keep in mind, these are quite high dosages, they are dangerous to use without a doctor's supervision!
Topical preparations:
- 1% grisemine emulsion
- Nystatin ointment
- 2% solution of flavofungin (alcohol)
- 0.5% lutenurine emulsion
- Nitrofungin
- 1% solution of fungenin (alcohol)
- Alcohol solution of gentian violet
- 0.2% solution of sanguinarine (alcohol)
- An aqueous solution of the sodium salt of levorin
- An aqueous solution of the sodium salt of nystatin
- Liquid Castellani
- A solution of quinazole (aqueous and alcoholic)
- Kanesten
- 2% salicylic alcohol
- Amphotericin B
Drops are either instilled 4 times a day (usually 8 drops), or injected on turundas (a narrow cotton swab).
Video "From what the ears grow mushrooms":