Fungal Ear Infection: Otomycosis

Dr. K. R. Meghanadh

Causes | Symptoms | Diagnosis | Treatment | Complications | Prevention | FAQs

What is a Fungal Ear Infection?

A fungal ear infection or Otomycosis occurs in the outer part of the ear and its main characteristic or symptom is severe itching.

It is also technically called Fungal Otitis Externa. Otitis means ear infection. So, Fungal Otitis Externa translates to fungal infection in the external part of the ear.

What causes Fungal Ear Infections?

Aspergillus Niger(black-colored) or Candida(white-colored) fungi cause the outer ear canal fungal infection. Aspergillus Niger causes most otomycosis cases.

• Environmental Presence: Aspergillus Niger and Candida spores are present in the environment, contributing to infection risk.
  

• Unclean Objects: Using unclean objects to clean ears, especially after bathing, can trigger fungal infections.

• Moisture Impact: Water in the ear can make the skin of the ear canal fragile, leading to deeper wounds and outer ear infections.

• Environment Role: Damp or humid environments can promote fungal growth, increasing the likelihood of infection.

To know more about ear infection causes, please refer to our article "What causes ear infection".

Picture of a fungal ear infection or Otomycosis - Aspergillus Niger fungus(black colored spots) spotted in ear - canal using endoscopy

Risks

Role of Humid Climates in Causing Otomycosis

As mentioned earlier, moisture in the ear promotes fungal growth. Additionally, when the climate is humid, the chances of fungal ear infection or otomycosis increase.

These cases are more common in coastal areas. In fact, bacterial otitis externa is the second most common ear infection in non-coastal regions, but the same place is taken by fungal otitis externa in coastal regions.

Ear infection due to earbuds

When earbuds or any external objects are used to clean ears, they can cause a rupture of the skin in the ear canal. This rupture skin can be easily subjected to an infection, either bacterial or fungal.

As most people tend to clean their ears after a shower, the skin in the ear canal can be wet, making it more sensitive. So, after a shower, the skin can easily rupture, and can lead to an outer ear infection (Otitis Externa), that can be either fungal or bacterial or both.

Check out the case study of a spike in otomycosis in a non-coastal area.

Spike of fungal ear infections during COVID-19

Fungal Ear Infection Symptoms

Fungal ear infection symptoms occur in this order

1. Itchiness in the ears

2. Pain in the ear

3. Deafness - perforation of the eardrum

Severe Itchy Ears

The fungus grows and feeds on the wax when conditions are ideal for its growth, for example, when your ear is wet. While the fungus is eating the wax, we experience itchy ears.

Pain in the Ear

After the completion of the wax, fungus encroaches on the ear canal’s skin, causing pain in the ear.

Deafness due to perforation

The itching present before can worsen when fungus creeps onto the skin. It could even create perforation of the eardrums leading to deafness. This deafness could be a permanent one.

Otomycosis Diagnosis

An ENT can diagnose Otomycosis using an otoscope and looking into the ear.

Visiting an ENT for appropriate diagnosis and treatment of ear infections is essential. An ear infection can spread to different parts of the ear, and only a doctor can diagnose and treat it properly to stop it from causing more damage.

Sometimes a person can have both fungal otitis externa and bacterial otitis externa too. Only an ENT doctor can recognize this using an otoscope.

Fungal Ear Infection Treatment

Fungal ear infection treatment involves two steps.

1. Cleaning of fungus in the ear canal

2. Antifungal ear drops

An ENT will clean the ear and remove the fungus in the ear. Antifungal ear drops will kill the remaining fungus and stop it from growing further.

Otomycosis Complications

Otomycosis Complications occur when left untreated or by using home remedies that can aggravate the situation.

1. Permanent perforation of the eardrum

2. Infection spreading to the middle ear

Permanent hole in eardrum due to Otomycosis

As mentioned earlier, perforation of the eardrum can occur when not treated on time in the case of fungal otitis externa. When further untreated, the perforation can become permanent, requiring major surgery for its restoration.

Otitis Media due to Fungal Ear Infection

After the eardrum is perforated, the middle ear gets exposed to the external environment for which it is not prepared or not used to. So, this exposure can lead to Otitis Media.

When do complications occur in fungal ear infections?

The above-mentioned complications occur for two reasons

1. Neglect

2. Home remedies

Neglect of Otomycosis

Neglecting otomycosis can lead to its rapid spread and worsening of symptoms. It typically begins with intense itchiness, which is soon followed by pain. If left untreated, the infection can progress to affect the eardrum, potentially causing perforation. Even after perforation, timely treatment is crucial, as failure to do so may result in a permanent hole in the tympanic membrane. The exposed middle ear can also be infected due to a hole in the eardrum. However, all these complications can be easily avoided by taking the infection seriously and promptly seeking appropriate medical attention. Early intervention can prevent the infection from advancing and protect your ear's health in the long run.

Fungal Ear Infection Home Treatment

Unfortunately, there are no effective home remedies for fungal ear infections. In fact, two commonly used in-home treatments for ear infections can worsen the condition instead of providing relief.

Oil as ear drops

Some people believe that using oil in the ear can help alleviate itching, assuming it's due to dryness of the outer ear canal. However, this itching may actually be caused by a fungal ear infection. When oil is applied in such cases, it acts as food for the fungus, promoting its growth and causing the infection to spread faster, ultimately worsening the condition.

Self-prescribed antibiotic ear drops

Another common misconception is that antibiotic ear drops can help with itchy ears. These drops may kill the normal bacteria present in the ear canal. Usually, bacteria and fungi coexist in a balanced environment, keeping each other in check. Using antibiotic ear drops disrupts this balance, creating an environment where the fungus can thrive unchecked. As a result, the infection will spread more rapidly and become harder to control.

Prevention

Otomycosis, a fungal ear infection, is largely preventable, primarily caused by unsanitary ear-cleaning practices. To keep it at bay, remember this simple rule: avoid cleaning your ears altogether. If you feel the need to clear them, refrain from doing so immediately after a shower or if water is present in your ears. Taking these precautions can significantly reduce the risk of developing otomycosis.

Dr. K. R. Meghanadh

FAQs

Why does fungal infection occur in the ear?

Fungal ear infections, also known as otomycosis, occur due to factors such as moisture in the ear, humid climate, using antibiotic ear drops without a prescription, and cleaning ears using external objects. These conditions create a suitable environment for fungi to thrive in the ear canal leading to fungal ear infection.

How do I know if my ear infection is fungal or bacterial?

Differentiating between a fungal and bacterial ear infection is easy.

A fungal ear infection starts in the outer ear canal and causes severe itching, followed by pain.

Bacterial ear infections usually start in the middle ear and are often caused by the common cold. Symptoms may include ear pain, fever, hearing loss, ear discharge, and ear blockage.

Always consult an ENT doctor, as ear infections can be in many parts of the ear. It is better to leave the diagnosis to experts.

Read our article "What Causes Ear Infection" for more details.

Is fungal ear infection serious?

Yes, fungal ear infections(otomycosis) are serious. It can cause perforation of the eardrum, leading to permanent hearing loss.

Visiting an ENT doctor to treat otomycosis is not optional.

How do you get rid of a fungal ear infection?

We cannot get rid of fungal ear infections without an ENT doctor's intervention. This is because it involves cleaning out the fungus from the ear canal, followed by antifungal ear drops prescribed by the ENT doctor. Suppose the fungal infection becomes more severe or spreads to the eardrums. In that case, We may also need major ear surgery to fix permanent hearing loss.

Can fungal ear infections spread to the brain?

Fungal ear infections or Otomycosis typically cannot spread to the brain. Fungal infections in the ear are mostly curtailed to the outer ear canal.

However, in extremely rare neglected cases, they can potentially trigger a chain of infections that might eventually lead to a brain infection. At the same time, no such case has been documented to date.

Untreated fungal ear infections (Otomycosis) can cause ear drum perforation, exposing the middle ear to external factors. This exposure may lead to a bacterial infection known as Otitis Media. When Otitis Media is left untreated, it can progress to Otitis Interna, affecting the inner ear. In highly unusual circumstances, this series of infections could hypothetically progress to the brain, causing conditions like encephalitis or meningitis.

It's crucial to emphasize that such a sequence of events is exceptionally rare and has not been reported so far.