ENT

Otomycosis (Fungal Ear Infection)

کان میں فنگس

Itching in the ear and ear blockage with greenish or white discharge. How to tell wax, otitis media and otomycosis apart matters, but the book stresses that examining the ear and experience are what differentiate them.

ICD-10: —
Source: OPD handbook pp.123–126
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Itching in the ear
Ear blockage

Diagnosis

Greenish / white discharge in the ear
Differentiating: wax is more common and gives blockage of the ear; otitis media gives earache that is severe, with a discharging ear; otomycosis gives severe itching
Thick whitish discharge with some spores seen (sample 2)

Treatment

Step 1 of 5

1. Suctioning and clearance

Clear the ear canal

Step 2 of 5

2. Topical antifungal

Cutis lotion and Terbisil lotion = terbinafine
Dermosporin drops = clotrimazole + hydrocortisone, 3+3+3 drops for 21 days (cost-effective)
Cutis / Terbisil are expensive, but Cutis has better results

Prescription

TerbinafineTopical antifungal

DoseAs directed (more expensive; Cutis has better results)

Brand Cutis lotion / Terbisil lotion

Also sold as Terbisil, Cutis

Clotrimazole + HydrocortisoneTopical antifungal + steroid

Dose3+3+3 drops

Brand Dermosporin ear drops 21 days

Step 3 of 5

3. Topical antibiotic (to prevent superadded bacterial infection)

Advise Cipocaine drops, preceded by Dermosporin drops (10 minutes gap)

Prescription

Ciprofloxacin + Lignocaine (xylocaine) ear dropsTopical antibiotic + local anaesthetic

Dose3+3+3 drops, 10 minutes after Dermosporin

Brand Cipocaine ear drops 7 days (sample)

Step 4 of 5

4. Antihistamine and painkiller

Antihistamine: Sedil / Rigix

Prescription

CetirizineAntihistamine

Dose1 at night

Brand Tab Sedil 10 mg / Rigix 10 mg 7 days

Also sold as Rigix, Sedil, Antial, Neo-Antial, Cetrix, Zyrtec

Diclofenac sodiumNSAID

Dose1+1 if pain, as needed

Brand Tab Voren 50 mg

Also sold as Voren, Diclo, Dicloran

Step 5 of 5

5. Counselling (Urdu notes)

Do not let water in the ear; keep the ear dry
Do not put match-sticks in the ear
Apply oil on cotton while bathing and place it in the ear
Avoid the advice of relatives

Sample prescriptions from the book (patient details removed)

Male, 40 y, severe itching in the left ear and ear blockage for 1 week; greenish thick discharge in ear canal: suctioning and clearance; Dermosporin drops 3+3+3 for 21 days; Cipocaine ear drops 3+3+3 for 7 days; Tab Sedil 10 mg at night for 7 days; Tab Voren 50 mg 1+1 in case of pain.
Female, 28 y, severe itching in ear for 3 weeks; thick whitish discharge, some spores seen: suctioning and clearance; Cipocaine ear drops 3+3+3 for 21 days; Dermosporin ear drops 3+3+3; Tab Rigix 10 mg at night for 7 days; Tab Voren 50 mg 1 as needed.