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Q. Will otomycosis spread to my middle ear through the hole in my eardrum?

Answered by
Dr. Sandeep Shrestha
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Sep 11, 2020

Hello iCliniq team,

I currently have otomycosis in my right ear (ear swab positive for a. niger), that perforated my eardrum 10 days ago. Current Symptoms: conductive hearing loss, tinnitus, ear pain has improved and is only sporadic now, no more drainage from middle ear, strange popping noises on TM post drainage, daily sporadic discomfort in the bone just behind/above my ear, but not severe (I’ve had this skull discomfort since the otomycosis diagnosis).

I received 3 courses of antibiotics prior to this diagnosis (amoxacillin, cefuroxime, clarithromycin) and ciprodex ear drops for a presumed bacterial ear infection...

Prior to the TM perforation, I had 3 days of locacorten antifungal drops upon discovery of white/black fungal growth, and stopped due to the perforation... in hindsight, I’ve had otomycosis when a ER doctor saw something black on my TM, but thought it was dried blood, and then gave me cefuroxime.

Treatment regarding otomycosis with perforation:

I’ve received 4 suction debridements of fungal debris against my eardrum, and been treated with clotrimazole 1% cream daily for 10 days so far (3 days was treated with nystatin cream post suction)... My TM is inflamed, and the hole can’t really be seen because it must be small, and the ear canal also seems to be improving due to cream treatment according to my last debridement... This particular ENT just prescribed me amox/clav for 7 days even though I’ve already taken 3 courses of antibiotics... What do you think?

My questions: Do I also need Oral antifungal medication combined with the antifungal cream considering I have a TM perforation? Will the fungus spread to my middle ear through the hole? Does my sporadic/non severe discomfort in the bone behind/above my ear mean the fungus is spreading? Or is it just a typical symptom? Will my hearing go back to normal? (I have conductive hearing loss as per a hearing test, and my sensorineural hearing was still in normal range).

#

Hello,

As per your concerns you don’t need oral anti fungal as it is improving, I would rather prefer a candibiotic ear drops as it will be more effective in both otomycosis and congestion of tympanic membrane. Chance of spread of otomycosis into the middle and inner ear is very rare, you don’t have to worry for now. It can just be the symptoms however you have to be careful in case tenderness over the mastoid area. If the perforation is small then it will heal on itself if there is no existing infection and your hearing might be normal.

Hope this will help you Thank you


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