Question
Otomycosis
Answer
Otomycosis is a fungal infection of the external auditory canal, most commonly caused by Aspergillus species (particularly A. niger, producing characteristic black spores/debris) and, less commonly, Candida species — an important cause of chronic/recurrent otitis externa, especially in hot, humid climates.
Predisposing factors: humid climate, swimming/water exposure, hearing aid/earplug use, chronic topical antibiotic/steroid ear drop use, diabetes, and immunosuppression.
Clinical features: intense itching, aural fullness, otorrhoea; otoscopy may show debris resembling “wet blotting paper”, sometimes with visible black spore heads (A. niger).
Laboratory diagnosis: direct microscopy (KOH mount) of ear discharge showing fungal hyphae/spores; culture on Sabouraud dextrose agar for species identification.
Treatment: thorough aural toilet is the single most important step; topical antifungal agents/acidifying agents; addressing predisposing factors to prevent recurrence.