Question
Otomycosis.
Answer
Otomycosis is a fungal infection of the external auditory canal, most commonly caused by Aspergillus species (particularly A. niger, which characteristically produces black spores/debris, and A. flavus) and, less commonly, Candida species — an important cause of chronic/recurrent otitis externa, particularly in hot, humid climates.
Predisposing factors: humid/tropical climate, swimming or water exposure, use of hearing aids or earplugs, chronic use of topical antibiotic/steroid ear drops (which disrupt normal protective flora), diabetes mellitus, and immunosuppression.
Clinical features: itching (often intense and a prominent early symptom), a feeling of fullness/blockage in the ear, otorrhoea (discharge), and mild discomfort/pain; on otoscopic examination, characteristic fungal debris resembling “wet blotting paper” or “wet newspaper” may be seen, sometimes with visible fungal hyphae/spores, and — with Aspergillus niger infection — distinctive black/dark-coloured spore heads studding the debris.
Laboratory diagnosis: direct microscopy (KOH mount) of ear discharge/debris demonstrating fungal hyphae/spores; culture on Sabouraud dextrose agar for species identification.
Treatment: thorough aural toilet (cleaning/removal of debris under direct vision) is essential and often the single most important step; topical antifungal agents (clotrimazole, or acidifying agents such as diluted acetic acid) applied after cleaning; systemic antifungal therapy is reserved for refractory or invasive disease; addressing predisposing factors (avoiding water exposure, discontinuing unnecessary topical antibiotic/steroid drops) to prevent recurrence.