Don’t Give Me an Earful: Your Guide to Otomycosis — a Fungal Ear Infection

The human ear is a design marvel. Based on intricate canals and the physics of air currents, the ear grasps sounds around you. At the same time, its direct exposure to the environment often exposes it to many maladies. Amongst them are fungal infections or otomycosis (oto – related to the ear; mycosis – fungal) that are somewhat enigmatic but very painful. It is vital you understand ear infection symptoms and when to seek ear infection treatment to prevent unnecessary complications.

Fungal ear infections are predominantly an external ear issue — starting in the outer ear and extending to the eardrum. Commonly caused by the Candida and Aspergillus strains of fungi. This infection starts when your ears are exposed to a warm, wet environment, and your body’s immunity is compromised. They are common in summer and in people who swim, surf, or participate in similar sports. Uniquely characterised by subtle, slow, and masked symptoms, otomycosis may infect your middle ear, too, but rarely.

Fungi thrive in warm, moist environments with organic food sources. The ear has it all. 

Possible causes of ear infections include:

• The earwax (cerumen) is essentially secreted to entrap dust, fungal spores, mites, etc., and protect the ear. However, improper cleaning of ear wax with cotton buds, inadequate drying of the ears after a water sport, or excessive build-up of ear wax can serve as a warm feeding ground for fungi. 
• Studies on the causes of ear infections show that using steroids or antibiotic ear drops alters the pH status of the ear canal and the natural skin bacteria, welcoming fungal infections. 
• A weakened immune system, caused by a recent history of prolonged illness, compromises the body’s defences. Healthy external auditory canal skin is home to many natural bacteria and fungi. These can become hazardous if the equilibrium is disturbed by the aftereffects of medicines. 
• Sometimes, the shape of the ear canal or the use of hearing aids may also contribute to ear infections.

The initial ear infection symptoms are subtle and slow and stealthily progress to full-blown ear pain.

• It starts with an itch. Mild itching soon intensifies so that your fingers often involuntarily reach the ears. This follows mild to moderate earache. 
• You notice dry, flaky skin coming out of the ears; this may follow a discharge that is more than earwax (blackish, greyish, yellowish, or red). By now, the pain crescendos may happen in severe bouts, accompanied by burning. 
• Your ears might start to feel clogged, and you might experience a mild ringing sensation (tinnitus) and poor hearing.
• In severe cases, the ear may look swollen and discoloured to reddish-purple, accompanied by headaches. 

Of note, ear infection symptoms in otomycosis are nearly non-differentiable from bacterial ear infections. Thus, it’s best not to self-diagnose but to consult a physician. 

The diagnosis of an ear infection is heavily dependent on what you tell the doctor about your ear issues and the tests that follow. Otomycosis can be tricky to identify, especially when there are mixed infections involving both bacteria and fungi. Common bacteria found in these mixed infections include Staphylococcus aureus and Pseudomonas species.

The clinician starts by asking you questions about the ear infection symptoms. He or she then uses an otoscope (a handheld magnifying instrument) to examine the ear canal). If they see the coloured discharge, swollen ear canal, and more, they advise further tests to analyse the ear discharge sample. Testing bacterial and fungal cultures might be time-consuming, but it avoids misdiagnosis. 

The variability of features and causes does not support just one particular treatment protocol for ear infections. Therefore, doctors must carefully evaluate evidence and patient conditions and use their clinical judgement to decide the best treatment. 

Ear cleaning with suction and irrigation tools will remove the ear discharge. This also follows thorough drying of the ear. In the absence of a wet, waxy environment, fungus fails to thrive. Ear drops may also accompany meds to reduce pain and discomfort. 

You may also need to be careful not to wet the ears too much while bathing, ensure they are dry after a shower, not pick on the ears with anything and everything, and avoid water sports for a while. 

A fungal ear infection is a subtle, slowly progressing ear issue that may cause severe earache and spread if left untreated. Starting with a mild itch and discomfort, it may snowball into severe loss of hearing with time. Having said that, it is not life-threatening but debilitating. Never jump into self-diagnosing, and always approach an ENT for correct diagnoses, lab tests, and treatment plans. Regular ear drying after showers or water sports, using disinfected ear cleaning tools, and ear checkups are the best ways to stay away from ear infections. 

Treatments for fungal ear infections vary based on the patient's condition and medical history. The two most common treatments are ear cleaning and irrigation to eliminate the build-up and ear drops to prevent the spread of fungal strains. 

Severe, unattended otomycosis from the outer ear can spread to the brain through the bone and enter the bloodstream, especially in immunocompromised patients. 

If you contract fungal spores from water sports, have poor immunity, or use unclean ear aids or cleaning tools, then fungi may reach your ears. Earwax and the moist environment in the ear canal help the fungus grow.

Physicians can diagnose the fungal infection using clinical exams and lab tests. Treatment for otomycosis involves ear cleaning, putting antifungal ear drops, and lifestyle restrictions.

The treatment for otomycosis can take anywhere from 2-3 weeks to subside, provided you strictly follow all routines.