Role of Clotrimazole in Prevention of Recurrent Otomycosis

Philippine Journal of Otolaryngology-Head and Neck Surgery, 2008

To determine the antimycotic activity of the four medicinal plant extracts, kalachuchi bark (Plumeria acuminata Ait.), atsuete bark (Bixa orellana Linn.), akapulko leaves (Cassia alata Linn.), and neem leaves (Azadirachta indica Adr. Juss), when compared to the standard clotrimazole in the treatment of otomycosis. Study Design: Experimental Study Methods: Taxonomically identified plants, kalachuchi, atsuete, akapulko, and neem tree were collected and deposited in an herbarium. Extracts of these plants and the standard clotrimazole were tested against isolates of Aspergillus flavus, Aspergillus niger, and Candida albicans taken from patients with otomycosis. Three trials were made for each extract using different solvents and results subjected to statistical analysis. Result: Of the four medicinal plant extracts studied, only kalachuchi bark extract exhibited antifungal activity against Aspergillus flavus and Aspergillus niger using methylethylketone as solvent when compared to the standard clotrimazole. It was equally effective in inhibiting the growth of A. flavus and A. niger. However, all plant extracts using all types of solvents were equally ineffective in inhibiting the growth of Candida albicans. Conclusion: This in vitro study suggested that kalachuchi (Plumeria acuminata Linn.) bark extract inhibits the growth of Aspergillus species and was comparable to the standard clotrimazole. Following appropriate further studies and clinical trials, it may be a potential alternative treatment option for otomycosis caused by Aspergillus species.

International journal of pediatric …, 2008

Asian Journal of Medical Sciences

Background: Otomycosis is a superficial mycotic infection of the external auditory canal. Clinical presentation, along with otoscopic findings, is sufficient to make the diagnosis in most of the cases. Treatment includes aural cleaning followed by the instillation of anti-fungal ear drops. In the recent years, there has been an increasing trend of antifungal resistance for the commonly used antifungals such as fluconazole and clotrimazole. Drug sensitivity patterns have also shown variability from one region to another. Aims and Objectives: To evaluate the clinico-mycological profile along with antifungal susceptibility pattern and treatment outcome of primary otomycosis. Materials and Methods: A total of 230 clinically diagnosed patients of primary otomycosis were included in this prospective study. Microbiological causes were evaluated by KOH wet mount and culture of samples collected from external auditory meatus using sterile swabs. Fungal culture was done on Sabouraud dextrose ...

Journal of evolution of medical and dental sciences, 2013

BACKGROUND: Otomycosis is a superficial mycotic infection of the external auditory canal. The infection may be either subacute or chronic in nature. Otomycosis occurs worldwide but is more common in tropical and subtropical countries. Fungal agents most commonly causing otomycosis are Aspergillus niger, Candida albicans, Aspergillus flavus, Aspergillus fumigatus, Candida parapsilosis, Penicillium, Mucor, Rhizopus, Absidia and Scopuloriopsis spp. Many agents have been recommended for treating otomycosis, but no preparation has been widely accepted. Vigorous cleaning of the external auditory canal remains the mainstay in treating otomycosis, along with usage of topical anti-fungal agents. OBJECTIVE: To compare the efficacy of chloroxylenol (Dettol) and chlorhexidine-cetrimide (savlon) with 1% clotrimazole+1% lidocaine ear drops. METHODS AND MATERIALS: Agar well diffusion method was used on the isolates obtained from uncomplicated clinically diagnosed otomycosis cases. RESULTS: The isolates, Aspergillus niger, Aspergillus flavus, Candida albicans, Candida glabrata and Candida parapsilosis were susceptible to undiluted concentration of dettol and not susceptible to savlon. CONCLUSION: Dettol can be used to reduce the fungal burden in the external auditory canal, and it should be followed by topical application of clotrimazole ear drops to cure the disease.

American Journal of Otolaryngology, 2018

To demonstrate non-inferiority of eberconazole 1% otic solution to clotrimazole 1% solution, and to compare their safety profile in the treatment of otomycosis. Materials and Methods: Multicenter, randomized, double-blind, active treatment-controlled phase 3 clinical trial. One hundred and ninety patients with diagnosis of otomycosis were randomly assigned to eberconazole 1% otic solution or clotrimazole 1% solution. Results: Baseline characteristics were comparable between both groups for age, gender, ethnicity, and clinical variables. Both study groups had high complete response rates: 81.8% in the eberconazole group and 83.5% in the clotrimazole group. Although non-inferiority of eberconazole relative to clotrimazole could not be demonstrated, a post-hoc sensitivity analysis demonstrated that eberconazole 1% otic solution was not inferior to clotrimazole 1% solution for the primary efficacy endpoint. Secondary endpoints also demonstrated that eberconazole 1% and clotrimazole 1% solutions were therapeutically similar at the end of the study. The incidence of adverse events was similar in both groups, and none had related AEs and withdrawals due to an AE. Conclusions: Eberconazole 1% otic otic solution is an efficacious and safe option to treat otomycosis-affected patients in the general practice.

International Archives of Otorhinolaryngology, 2018

Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being th...

Journal of Bio-Science, 2019

Otomycosis is a chronic ear disease of external auditory canal and it is more prevalent in warm, humid and dusty environment, although it is now found throughout the world. The most commonly found causative agents as of fungal species are Aspergillus and Candida along with preponderance of various fungal and bacterial species has also been reported. The aim of this review is to focus on the prevalence of causal agents of otomycosis in the global context and its clinical management. A total of 63 research articles have been reviewed, which deals prevalence of otomycosis. Its clinicomycological studies both separately and altogether with folk medicine in relation to treatment of otomycosis were also reviewed. Findings of various reports revealed that the Aspergillus and Candida species are the main causal agents of otomycosis. But many reports indicate that a few of other fungal species along with bacteria particularly Staplylococcus aureus and Pseudomonas aeruginosa are also responsi...

Journal of Evolution of medical and Dental Sciences, 2014

Otomycosis is a fungal infection of External auditory canal. Otomycosis has worldwide distribution with high prevalence in hot, humid and dusty climates of tropical and subtropical regions. Management of Otomycosis is dependent on thorough understanding of anatomy of external ear canal, knowledge of microbiology and pathophysiology of potential pathogens. OBJECTIVES: To determine importance of various aetio-pathological factors in causation of Otomycosis. To study pattern of fungal isolates encountered in cases of Otomycosis. To study management of the disease. MATERIALS AND METHODS: This study was undertaken in the Department of Otorhinolaryngology, Sri Siddhartha Medical College & Hospital, Tumkur from January 2012 to December 2012. It was a time bound study, wherein 51 cases were studied. OBSERVATION AND RESULTS: Highest incidence (25.5%) was noted in age group of 21-30 years. Common predisposing factor was use of unsterile material for cleaning ear in 55.3% cases. Fungal debris ...

ISRN Otolaryngology, 2013

Objectives. Otomycosis is a common ENT disease frequenting the tropics. Its recurrent nature poses a great challenge to the treating physician. In spite of a number of antifungals in the market, the frequent nature of this disease warrants repeated use of these drugs, contributing to drug resistance and financial burden on the rural population. Our primary aims were to evaluate the effectiveness of povidone iodine in the treatment of otomycosis and to identify the most common fungal isolate in our population. Study Design and Setting. A single blinded prospective longitudinal study was done over a period of 12 months in a tertiary referral center. 34 patients in the age group 15-70 years clinically diagnosed with otomycosis were included in this study. These individuals were divided into two groups selected randomly. One arm received 7.5% povidone iodine otic drops and the other 1% Clotrimazole and lignocaine drops. Evaluation was based on resolution of symptoms and signs after treatment. Result. Both arms showed improvements which were comparable thus suggesting the role of povidone iodine in the management of otomycosis. Conclusion. Povidone iodine is an effective antifungal in the treatment of otomycosis.

IOSR Journals , 2019

Otomycosis or fungal otitis externa is a superficial, sub-acute or chronic infection of the external auditory canal, usually with unilateral presentation characterized by inflammation, pruritis, scaling and otalgia. Aim Of The Study: To find the prevalence of otomycosis along with its clinicomycologicalprofile,to explore specific predisposing factors,to isolate and identify the causative fungus and antifungal susceptibility testing for moulds by E test and for yeast by disk diffusion method. Methodology:Ear swabs were collected from 30 clinically suspected cases of otomycosis and all the samples were processed by direct microscopy of KOH mount and Gram staining. Culture was carried out on SDA.The identification process of the isolated fungus was done by standard procedures. Antifungal sensitivity of moulds was performed on RPMI 1640 agar supplemented with 2% glucose and tested for fluconazole (0.016-256 mcg/ml), Itraconazole(0.002 mcg/ml to 32 mcg/ml) and Caspofungin (0.002-32 mcg/ml) (HiMedia) by E strip .AFST for yeast was performed by the disc diffusion method on Mueller Hinton Agar supplemented with 2% glucose and 0.5mg/ L Methylene Blue (HiMedia)and tested for Fluconazole (10μg),Nystatin (100U), Amphotericin (100U), Ketoconazole (10μg) and Clotrimazole (10μg) disk (HiMedia). Result And Conclusion:Otomycosis was diagnosed in 100% of the cases with highest prevalence in 21-40 years of age group with a female preponderance.Itching was found to be the commonest symptom followed by ear pain.Ear pricking with hard objects was found to be the most common predisposing factor followed by swimming or pond bath. Seven cases were associated with tympanic membrane perforation. Of the 30 cases 32 number of fungi were isolated. Fungal isolates were predominantly mould (90.62%) while rest were yeast (9.38%). Mixed infection with more than one fungus was seen in 2 cases (6.67%). A.niger was the predominant fungus (71.88%) followed by A.flavus(18.75%) and C.tropicalis(9.37%). All the yeasts were found to be sensitive to Ketoconazole,Nystatin and Amphotericin and all moulds were found to be resistant to fluconazole.

NATIONAL JOURNAL OF LABORATORY MEDICINE

The samples were collected under aseptic conditions using sterile cotton swab from the external auditory canal. To diagnose otomycosis, detailed history, clinical examination, otoscopic findings and laboratory identification of fungus were considered [9].

Microbes and Infectious Diseases, 2020

Background: Otomycosis has been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Otomycosis is challenging for both patients and otolaryngologist as it frequently requires long term treatment and follow up. Inspite of proper treatment and follow up, the recurrence rate remains high. The aim of current study is to detect the most common fungi in otomycosis patients and determine its risk factors. Methods: The study included 194 patients clinically diagnosed with otomycosis. Each swab is subjected to direct microscopic examination with 10 % KOH and culture on Sabroud's dextrose agar (SDA) and blood agar. Filamentous fungal growth is identified by macro-and micro morphological characteristics. Yeast like growth is identified by (API 20C) AUX. Results: The mean age ±SD of the patients was 24.18± 15.9 years. Males (n=106,54%), were more vulnerable to otomycosis than females (n=88, 45%). The most common presenting symptom was otorrhea and pruritus (n= 78 ,40%) with unilateral involvement being more common. The most common predisposing factor is self-cleaning (n=84 ,43%) followed by topical antibiotic ear drops with steroid use (n=30,15%). Aspergillus fumigatus was the most common fungus causing otomycosis in this study (n=70, 36%) followed by Candida tropicalis (n=28,16%). Positive fungal cultures were observed in 180 specimens (90%). Conclusion: Otomycosis was common in people with the bad habit of self-cleaning with unsterilized objects and using unnecessary steroid containing ear drops. Aspergillus fumigatus and Candida tropicalis were the most prevalent isolated fungi in otomycosis patients.

Brazilian Journal of Otorhinolaryngology (Impresso), 2009

Ot omycosis is a fungal infection of the external ear canal with only a few studies about its real frequence in Brazil. Aim: to evaluate otomycosis frequence and characteristics in patients with clinical suspicion of external otitis. Study design: Retrospective study with transversal cohort (2000-2006). Materials and methods: 103 patients were assigned to mycological diagnosis (direct microscopic examination and culture). Results: Otomycosis was diagnosed in 19.4% of the patients. Patient age varied from 2 to 66 years (an average of 23.5 years of age), and 60% of otomycosis cases were seen in women between 2 to 20 years of age. Chronic otitis, previous antibiotic therapy and the lack of cerumen were predisposing factors; itching, otalgia, otorrhea and hypoacusis were the symptoms reported by the patients. The most frequently isolated species were C. albicans (30%), C. parapsilosis (20%), A. niger (20%), A. flavus (10%), A. fumigatus (5%), C. tropicalis (5%), Trichosporon asahii (5%) and Scedosporium apiospermum (5%). Conclusions: Otomycosis is endemic in JoAEo Pessoa-PB. Clinical exam and mycological studies are important for diagnostic purposes because otomycosis symptoms are not specific.

Iranian Journal of Public Health

Background: Otomycosis is a superficial infection of the ear caused by a spectrum of various fungal agents and its epidemiology depends on geographical region and climatic condition. The aim of this study was to investigate the causal agents and clinical manifestations of otomycosis at a tertiary referral center in Tehran, Iran. Methods: From Apr 2016 to Jan 2017 a set of 412 subjects with suspicion of external otitis were included. Clinical examination and specimen collection were performed by an otorhinolaryngologist. Subsequently, direct examination and culture were performed on specimens and isolated molds were identified morphologically. Yeast isolates were identified using CHROMagar Candida medium and PCR-RFLP of ribosomal DNA whenever needed. Data were analyzed using SPSS. Results: Otomycosis was confirmed in 117 cases (28.39%) including 64 (54.7%) males and 53 (45.3%) females. Patients were within the age range of 10-75 yr and the highest prevalence was found in the age grou...

Asian Journal of Pharmaceutical and Clinical Research, 2018

Objective: This study was aimed to identify the public pattern of presentation, influencing factors, and sort the fungal species, distribution of sex of patients with otomycosis.Results: The predominant complaints were pruritus and found in 76 patients (88.73%), discomfort and pain found in 62 patients (72.09%), aural fullness in 48 patients (55.81%), tinnitus in 34 patients (39.53%), hearing impairment in 50 cases (58.31%), ear discharge in 22 patients (25.58%), and most of the symptoms seen in 36 patients (68.14%). The results showed a total of eight fungal species belong to six different genera, namely, Aspergillus, Candida, Penicillium, Rhizopus, Alternaria, and Cephalosporium were isolated during this study. Among identified fungi, Aspergillus niger was found to be the most prevalent fungal species with 35.71% followed by Candida albicans (27.55%), Aspergillus flavus (10.20%), Aspergillus fumigatus (8.16), Penicillium digitatum (6.12%) and Cephalosporium species (4.08%), and R...