||The underlying canal skin is often inflamed and granular, due to invasion by fungal mycelia.
In many patients, the typical appearance of otomycosis is masked by debris and the correct
diagnosis can only be reached by specifically culturing a sample of the exudate for fungi.
This is especially true for Candida albicans which has no specific visual diagnostic features.
A swab should therefore be sent for both fungal and bacterial cultures in all cases of chronic otorrhoea. In most laboratories, fungal cultures on Saboraud's medium are not routinely performed and must be specifically requested.
Thorough aural toilet by suction, dry mopping or gentle syringing with a cotton tipped applicator to remove every vestige of debris is once again the cornerstone of effective treatment.
Mastoid and fenestration cavities must be completely emptied of wax and infected material.
An appropriate topical antifungal preparation is then applied.
Refractory cases will require repeated aural toilet, with re application of an antifungal agent, selected in the light of laboratory culture studies, several times a week to effect a cure.
In those cases of otomycosis caused by Candida species, nystatin ointment or lotion is usually effective, while in those cases caused by Aspergillus species, a 1 % clotrimazole suspension is usually more effective.
The most effective method of treating both Candida and Aspergillus species is a single dose coating of the external canal with pure clotrimazole powder following debridement.
This is the same ear as shown in the previous photograph after debridement. Note the ulceration of the skin of the deep canal and the granular tympanic membrane, due to invasion by Aspergillus niger.