Patients with otolaryngology are increasingly receiving patients with complaints of ear congestion, hearing loss, and itching in the ear canal. This is how 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.
Causes of otomycosis
Otitis fungal etiology classified on the basis of the localization of inflammation. External fungal otitis is diagnosed in 62% of cases, fungal otitis media - in 20% of cases, postoperative fungal otitis media - in 17% of cases, fungal myringitis - in 1%.
In the role of the causative agent of otomycosis are the fungi Aspergillus (65%), Penicillium (10%). In 24% of cases, pathogens are Candida yeast fungi. 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 that invariably cause a general weakening of the body, hypovitaminosis, impaired metabolic processes.
Exogenous: local and systemic antibiotic therapy, taking corticosteroids for a long time, treatment with cytostatics, radiation therapy, ear injury (for example, with improper cleansing of the external auditory canal), bathing in open water. Often there is a lesion of the postoperative ear cavity.
Symptoms are directly dependent on the stage of the disease.
At the stage of precursors, objective changes are not detected, the patient feels only an ear congestion and itching. The fatty film disappears from the ear canal, its edema is observed. Most people take these symptoms for sulfur accumulation and attempt to clear the ear canal. The result is skin trauma and penetration of a fungal infection.
The acute stage of mycosis is characterized by the presence of discharge from the ear canal. The volume of discharge is constantly increasing, as, indeed, and puffiness. It provokes the overlap of the lumen of the ear canal, because of which hearing is reduced. If you carefully examine the selection, you can find in them the mycelium and epidermis of fungi. Individual patients note the presence of hypersensitivity in the ear region. Usually, the infection is limited to the skin of the outer ear, but in diabetics it can spread into the cavity of the middle ear.
The main symptom of mycotic otitis media is specific discharge, the consistency and color of which depend on the genus of otomycosis pathogens. This form differs from the previous hyperthermia of the eardrum; there are also perforations of different sizes. Patients also complain of frequent pain and even greater hearing loss.
Another type of otomycosis is fungal myringitis. In this form, the lesion extends to the eardrum.
Otomycosis of the postoperative cavity may occur after radical mastoidectomy or tympanoplasty. The reason - a long stay in the ear canal of cotton swabs, soaked with a solution of antibiotic and glucosteroids. Clinically, the disease is manifested by increased pain in the ear region, an increase in the amount of discharge from the ear.
Repeat, the symptoms of otomycosis are insidious - it is similar to classical otitis, so if you suspect a fungal infection, you should immediately contact a specialist and pass a few strokes - culture and microscopic. In identifying a pseudomycelia spore, the doctor will prescribe an adequate therapy.
Otomikoza therapy is known difficulties, primarily due to the lack of efficacy of drugs and frequent relapses, the high cost of antifungal agents.
For 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 how to treat various forms of otomycosis?
Regardless of the form of the disease, thorough cleaning of the ear precedes the local therapy. Its goal is to remove the pathological discharge, the remnants of which, even in a small amount, repeatedly reduce the effectiveness of treatment and increase the duration of treatment. Only a specialist makes it using a padded jacket moistened with an antimycotic drug and an attic probe.
With otitis media, special attention is paid to cleaning the eardrum separated from the perforation area. In the case of large perforations, the removal of the discharge is combined with the washing of the tympanic cavity with Miramistin (0, 01%, solution). Similarly come with otomycosis postoperative cavity. If polyps and granulations take place, they are removed or extinguished with silver nitrate (20%, solution).
External fungal otitis
Ointments, well-proven in the treatment of other candidiasis and mycoses, with otomycosis are ineffective. First of all, due to the impossibility of applying an even layer on the narrow in nature of the external auditory canal. Because of this, the most convenient form of drugs are suspensions, solutions and emulsion formulations.
Apply them as follows: moistened cotton wool turunds with a medicinal substance (gauze tampons can injure the skin) and leave in the ear canal 10-15 minutes (focusing on the instructions). Manipulations are repeated 4-5 times a day.
Step therapy with Exoderil :
1, 2, 3 days: twice a day 15-minute applications with Exoderil solution
4, 5, 6, 7 days: twice a day cream Exoderil
From 8 days for 3 weeks cream Exoderil 1 p. per day, and then 1 p. in 2 days another 2 weeks .
With this treatment regimen, microbiological diagnosis is repeated on days 7 and 45 of treatment.
In addition to Exoderil, treatment with such drugs as:
Candibiotics (drops) are contraindicated in perforation of the eardrum, in all other cases, drops provide a quick anesthetic result and reduce inflammation on the skin of the ear canal. Allowed during pregnancy and lactation. The only condition for use is short duration of use and small doses.
Dosing: 3-4 times a day, 4-5 drops per ear canal. The result is visible after 3-5 days, but the treatment should be continued for 7-10 days.
In addition to antifungal therapy, the treatment of concomitant diseases, refusal of antibiotics, fortifying treatment and vitamin therapy are important. If otomycosis occurs in a child, then antifungal treatment should be combined with the use of drugs that restore the intestinal microbiocenosis (acipol, bifikol, hilak forte, Linex, bactisubtil, lactobacterin, etc.).
If a low interferon status is detected, replacement interferon therapy is carried out (viferon in the form of candles and megasin on an ointment base).
Mycotic otitis media
Damage to the middle ear is considered a more difficult case and requires “shock” dosages of antimycotics.
- Nystatin - 3 000 000 U, course - two weeks, if necessary, repeat the course after a break of 10 days;
- Levorin - 2 000 000 IU, the duration is determined by the doctor;
- Amphoglyukamin - 400 000 IU, duration - 10 days;
- Mycoheptin - 5 000 000 IU, duration - 10-14 days;
Keep in mind, these are quite high dosages, it is dangerous to use them without the supervision of a doctor!
- 1% grizemin emulsion
- Nystatin ointment
- 2% solution of flavofungin (alcohol)
- 0.5% lutenurin emulsion
- 1% solution of fungenin (alcohol)
- Gentian violet alcohol solution
- 0.2% solution of sanguinarine (alcohol)
- Aqueous solution of levorina sodium salt
- Aqueous solution of nystatin sodium salt
- Castellani Liquid
- Chinosol solution (water and alcohol)
- 2% salicylic alcohol
- Amphotericin B
Drops are either buried 4 times a day (usually 8 drops), or injected on turunda (narrow cotton swab).
Video "From what mushrooms grow in the ears":