A fungal infection of the ear canal and can be caused by one of almost 60 different species of fungi.

Otomycosis refers to a fungal infection of the ear canal and can be caused by one of almost 60 different species of fungi. It is a fairly common condition, with a prevalence ranging up to 30%. Otomycosis may be an acute condition (appearing suddenly and resolving quickly) or chronic (lasting for over three months). It is usually found only in one ear, though it’s possible to develop the infection in both ears, especially in immunocompromised individuals.


Causes and Risk Factors for Otomycosis

Anyone can contract a fungal ear infection. However, there are certain factors that may increase your risk. A certain amount of fungi (and bacteria) are normally present on healthy skin, including within the ear canal; this is termed normal or resident flora. It’s when the organisms grow and proliferate that the skin’s normal flora becomes imbalanced and may start to cause the symptoms of an infection.

Fungi grow most prolifically in warm, moist conditions. The ear canal is already an ideal environment as the shape and size of it makes it easy for moisture to become trapped. You may be at a greater risk of a fungus-friendly environment if:

  • Your ears are not adequately dried after swimming, showering, or bathing
  • You live in a tropical or subtropical region with high environmental humidity
  • You regularly use earplugs, earbuds, or hearing aids that completely close off the ear canal
  • You excessively clean away the earwax from your ears (earwax offers anti-fungal properties)
  • You have other chronic medical or skin conditions
  • You typically wear a head covering that covers the ears, such as a turban or veil

Individuals who are immunocompromised or who have diabetes also tend to be at a higher risk of otomycosis. In premature babies, intubation, artificial ventilation, and episodes of respiratory distress have been linked to higher otomycosis risk.

On occasion, a fungal infection of the ear canal can be an unfortunate side effect of using antibiotics. The normal bacteria and fungi of the ear canal work to keep each other’s growth in check. The use of antibiotics kills the bacteria, which then opens the way for resident fungi to proliferate and potentially cause an infection.

Otomycosis Symptoms

In the early stages, otomycosis may be asymptomatic. As the infection progresses, common symptoms of otomycosis include:

You may also notice inflammation, swelling, and redness around your ears.

Otomycosis Treatment

Fungal ear infections, though unpleasant, are generally considered benign and are not life-threatening. However, they can be recurrent or chronic and rarely may cause complications, such as a ruptured eardrum or widespread infection.

Your family physician should be able to assess and diagnose otomycosis. Typically, taking a medical history and performing a basic physical exam with an otoscope to look inside the ear canal is sufficient. If there is any doubt as to whether the responsible pathogen is a fungus or bacteria, your doctor may also take a swab from your ears to send to a laboratory for identification.

Managing otomycosis can be approached in a few different ways. The treatment your doctor chooses will be based on the features of your infection, such as how severe it is, and whether you have risk factors for more advanced infection, such as being on immunosuppressive medications.

If your doctor decides that anti-fungal drugs will be the best treatment, this can be delivered via ear drops, topical ointments or creams, or orally. Common anti-fungal drugs include clotrimazole, fluconazole, and itraconazole. Any pain in your ear can usually be managed with over-the-counter pain relievers, such as acetaminophen.

Though most cases of otomycosis resolve well with an appropriate anti-fungal medication, some fungi may be resistant to drugs or the infection may continue to persist, turning into a chronic condition. In these situations, it would be wise to be under the care of an ENT (ear, nose, throat) specialist. An ENT doctor may perform a clean of your ear canal to flush out debris and reduce the fungal load. It is also not uncommon to be recommended to wash your ear canal with an alcohol and vinegar formulation, which removes dead skin cells and creates an environment that discourages fungal growth.

Otomycosis Prevention

Minimizing your risk factors for otomycosis is your best bet against developing this fungal ear infection. Though you may not be able to control the humidity if you live in a tropical region, you can:

  • Ensure your ears are thoroughly dried after getting wet
  • Avoid inserting objects into your ear canal to clean out earwax
  • Consider using drying ear drops after swimming
  • Managing existing skin conditions well, such as eczema

In summary, keeping your ears as clean and dry as possible will help to reduce your risk of otomycosis. Remember that earwax is an important part of your ears’ defense system, even though it may be tempting to clean it out. If you have issues with excessive earwax, your family doctor or ENT specialist can provide you with tips for safely treating this.