Otomycosis is a superficial fungal infection of the external auditory canal, commonly caused by Aspergillus and Candida species. It accounts for approximately 5-25% of otitis externa cases worldwide, with higher prevalence in tropical and subtropical climates. Predisposing factors include prior antibiotic or steroid ear drop use, trauma from ear cleaning, and humid environments. Clinical features include pruritus, otalgia, otorrhea, and conductive hearing loss due to fungal debris obstructing the ear canal. Otomycosis is increasingly recognized as a biofilm-related infection, which contributes to treatment failure and recurrence. Management centers on thorough aural toilet followed by topical antifungal agents.
Conditions with similar clinical presentations that must be differentiated from Otomycosis:
Target disease: Otomycosis (infectious; fungal infection of the external ear canal).
Otomycosis is a superficial fungal infection of the external auditory canal (EAC), often presenting with pruritus, otorrhea, otalgia, aural fullness/blockage, and sometimes hearing loss and tinnitus, and it may be acute, subacute, or chronic. (bojanovic2023etiologypredisposingfactors pages 1-2, alam2023astudyof pages 1-2, j.f.2025pooledanalysisof pages 1-3)
Across recent multicenter and regional datasets, Aspergillus spp. (especially the A. niger complex/section Nigri) and Candida spp. dominate the etiology, but geographic heterogeneity is substantial and mixed bacterial–fungal infection is common. (bojanovic2023etiologypredisposingfactors pages 1-2, roohi2023otomycosistheforemost pages 3-3, sn2024mycologicepidemiologyand pages 1-2)
Clinically, the evidence base continues to emphasize mechanical aural toilet/debridement plus topical antifungals, with emerging higher-quality RCT evidence supporting clotrimazole 1% otic solution versus placebo. (j.f.2025pooledanalysisof pages 1-3, sangare2021otomycosisinafrica pages 4-5)
Definition/overview: - “Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC)” (review-level definition). (bojanovic2023etiologypredisposingfactors pages 1-2) - “Otomycosis is a superficial fungal infection of the external auditory canal.” (prospective cohort definition). (alam2023astudyof pages 1-2) - Otomycosis is “a superficial infection involving the external auditory canal caused by yeasts and filamentous fungi.” (trial definition). (j.f.2025pooledanalysisof pages 1-3)
Synonyms/alternative names (clinical): otomycosis; fungal otitis externa; fungal infection of the external auditory canal; “ear fungus” (common usage in recent clinical literature). (bojanovic2023etiologypredisposingfactors pages 1-2, j.f.2025pooledanalysisof pages 1-3)
Most information here is derived from aggregated disease-level resources (systematic/literature reviews), complemented by human clinical cohort studies, cross-sectional microbiology studies, a multicenter randomized clinical trial program, and clinicaltrials.gov registry records. (bojanovic2023etiologypredisposingfactors pages 1-2, pereira2024topicalantibioticinducedotomycosis pages 1-2, j.f.2025pooledanalysisof pages 1-3, NCT01547221 chunk 1)
Otomycosis is an infectious disease caused by fungal colonization/overgrowth of the EAC under permissive conditions (humidity, barrier disruption, dysbiosis), with the most common agents being Aspergillus spp. and Candida spp. (bojanovic2023etiologypredisposingfactors pages 1-2, pereira2024topicalantibioticinducedotomycosis pages 1-2)
Key etiologic fungi (recent datasets): - Iran (2023; molecular identification): Aspergillus spp. dominated (88% of mold isolates), including Aspergillus section Nigri 57.4%, Flavi 18.8%, Fumigati 11.8%; yeasts included Candida parapsilosis (13.8%), C. orthopsilosis (5.9%), and C. albicans (4.9%). (roohi2023otomycosistheforemost pages 3-3) - Libya (2024; culture-based): Aspergillus spp. 82.67% of isolates; A. niger 41.16%, A. flavus 38.63%. (elarabi2024prevalenceandetiology pages 2-3, elarabi2024prevalenceandetiology pages 3-4) - Cameroon (2024; culture-positive cases): Candida albicans 38%, Aspergillus niger 26%, Candida spp. 22%, A. fumigatus 14%. (sn2024mycologicepidemiologyand pages 1-2) - India (2023; prospective): Among culture-positive cases, Aspergillus 91.1%, Candida 8.9%. (alam2023astudyof pages 1-2)
Pooled/quantitative risk factors (systematic review of topical antibiotic-induced otomycosis; published July 2024): - Ototopical antibiotics ± steroids: 47% (95% CI 0.38–0.56). (pereira2024topicalantibioticinducedotomycosis pages 1-2) - Oils/wax solvents: 38% (95% CI 0.26–0.51). (pereira2024topicalantibioticinducedotomycosis pages 1-2) - Trauma from cleaning/instrumentation: 37% (95% CI 0.21–0.54). (pereira2024topicalantibioticinducedotomycosis pages 1-2)
Study-level risk factors (Iran, 2023): cotton swab/manipulation 40.6%; topical antibiotics 42.6%; topical steroids 33.7%; prior bacterial otitis 31.7%; swimming 8.6%. (roohi2023otomycosistheforemost pages 3-3)
Environmental/host factors (review synthesis): tropical/subtropical climates, EAC hygiene practices/trauma, diabetes, and immunodeficiency are repeatedly highlighted across the literature. (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 2-3)
Direct protective factors are not quantified in the retrieved clinical studies. Mechanistically, intact cerumen/skin barrier and preserved ear-canal microenvironment are discussed as protective in review-level synthesis. (bojanovic2023etiologypredisposingfactors pages 2-3)
No host gene–environment interaction (GxE) evidence was identified in the retrieved corpus; otomycosis is treated as an acquired infection with risk driven by local environment, behavior, comorbidity, and iatrogenic factors (e.g., topical antibiotics). (pereira2024topicalantibioticinducedotomycosis pages 1-2)
Commonly reported symptoms/signs include: - Pruritus/itching (often the dominant symptom) (alam2023astudyof pages 1-2) - Otorrhea/discharge (bojanovic2023etiologypredisposingfactors pages 3-5) - Otalgia/ear pain (bojanovic2023etiologypredisposingfactors pages 3-5) - Aural fullness/blocked sensation (bojanovic2023etiologypredisposingfactors pages 3-5) - Hearing loss/hypoacusis (roohi2023otomycosistheforemost pages 3-3) - Tinnitus (roohi2023otomycosistheforemost pages 3-3) - Scaling/desquamation (roohi2023otomycosistheforemost pages 3-3) - EAC edema/erythema (bojanovic2023etiologypredisposingfactors pages 3-5)
Frequencies from recent primary studies: - India (2023): ear itching 70.9%. (alam2023astudyof pages 1-2) - Iran (2023): tinnitus 26.7%, hearing loss 19.8%, scaling 11.8%. (roohi2023otomycosistheforemost pages 3-3)
Otomycosis can be acute, subacute, or chronic, typically unilateral, with bilateral disease more frequent in immunocompromised patients. (bojanovic2023etiologypredisposingfactors pages 1-2)
Formal QoL instruments (e.g., SF-36, EQ-5D) were not reported in the retrieved corpus. The symptom complex (itching, pain, discharge, fullness, hearing symptoms) implies functional burden, but direct quantitative QoL data are currently a gap in this evidence set. (alam2023astudyof pages 1-2, roohi2023otomycosistheforemost pages 3-3)
(These are ontology suggestions; not directly asserted by the cited articles.)
No human causal genes/variants are implicated in the retrieved otomycosis evidence; the condition is not presented as an inherited monogenic disorder in these sources. (bojanovic2023etiologypredisposingfactors pages 1-2)
Molecular methods are used primarily to identify fungal pathogens (e.g., Aspergillus section/species determination), not host genetics. (roohi2023otomycosistheforemost pages 5-6)
Examples: - Roohi et al. (2023) describe PCR-based identification (PCR-RFLP and species/section-level identification). (roohi2023otomycosistheforemost pages 4-5, roohi2023otomycosistheforemost pages 5-6)
Predominant genera/species in recent datasets include Aspergillus (section Nigri/A. niger complex; A. flavus complex; A. fumigatus) and Candida (C. albicans, C. parapsilosis, non-albicans Candida). (roohi2023otomycosistheforemost pages 3-3, sn2024mycologicepidemiologyand pages 1-2)
A synthesis supported by 2023–2024 evidence: 1. Predisposing exposures (humidity, swimming, EAC trauma, topical antibiotic/steroid use, diabetes/immunodeficiency) alter local defenses. (roohi2023otomycosistheforemost pages 3-3, pereira2024topicalantibioticinducedotomycosis pages 1-2) 2. Disruption of normal ear-canal environment (including microbiome/pH and barrier integrity) facilitates fungal overgrowth; the 2024 systematic review emphasizes prolonged topical antibiotics as a driver of disruption that promotes fungal growth. (pereira2024topicalantibioticinducedotomycosis pages 1-2) 3. Fungal proliferation on EAC epithelium leads to inflammation, debris, scaling, discharge, and symptoms (itching, fullness, otalgia, hearing symptoms). (bojanovic2023etiologypredisposingfactors pages 3-5) 4. Persistence/relapse can be supported by pathogen traits such as biofilm formation (see below). (bojanovic2022clinicalpresentationscluster pages 4-6)
In a 30-patient single-center experience of laboratory-confirmed Aspergillus otomycosis, six patients had relapse at 60 days with the same Aspergillus species re-isolated, and “all six species isolated in the relapse episode had the ability to produce biofilm.” (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6)
GO biological process (examples): - GO:0006954 inflammatory response - GO:0009405 pathogenesis - GO:0009615 response to virus (not applicable); instead use general immune response GO:0006955 - GO:0044419 interspecies interaction between organisms (host–pathogen interaction)
Cell Ontology (CL) (examples): - CL:0000084 T cell (in immune response; not directly measured here) - CL:0000236 B cell (not directly measured) - CL:0000583 neutrophil (not directly measured) - CL:0000066 epithelial cell (EAC epithelium as the affected tissue context)
Note: These ontology mappings are mechanistic suggestions; the cited sources do not provide direct single-cell or immunophenotyping data.
Primary site is the external auditory canal (EAC); review-level evidence notes possible extension to the tympanic membrane and auricle, and bilateral disease is more common in immunocompromised hosts. (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 3-5)
Suggested UBERON terms (examples): - External auditory canal: UBERON:0001691 (suggested) - Tympanic membrane: UBERON:0004499 (suggested)
Otomycosis can be acute, subacute, or chronic. (bojanovic2023etiologypredisposingfactors pages 1-2)
Recurrence is a prominent clinical feature discussed across reviews, and in Aspergillus otomycosis a measurable relapse signal (6/30 at 60 days) is reported, with biofilm implicated. (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6)
Prevalence estimates vary by context and ascertainment: - 2023 literature review summarizes a worldwide prevalence “ranging from 9% to 30%.” (bojanovic2023etiologypredisposingfactors pages 1-2) - 2024 systematic review notes otomycosis accounts for ~5–20% of external ear infections worldwide (in the context of topical antibiotic-induced otomycosis). (pereira2024topicalantibioticinducedotomycosis pages 1-2) - Cameroon (2024): 50/100 participants had positive fungal cultures (study sample, not population prevalence). (sn2024mycologicepidemiologyand pages 2-3) - Libya (2024): fungal growth detected in 86.34% (177/205) of sampled ear swabs (study sample). (elarabi2024prevalenceandetiology pages 2-3)
Otoscopy/otoendoscopy is central; at least one prospective study states that clinical presentation plus otoscopic findings is often sufficient for presumptive diagnosis, but laboratory confirmation improves etiologic specificity and treatment selection. (alam2023astudyof pages 1-2, bojanovic2023etiologypredisposingfactors pages 3-5)
Common diagnostic components (review and primary studies): - Direct microscopy / KOH wet mount: rapid screening approach. (alam2023astudyof pages 1-2, bojanovic2023etiologypredisposingfactors pages 3-5) - Fungal culture (SDA and related media): described as the “gold standard” in review synthesis; proper incubation conditions are important for molds. (bojanovic2023etiologypredisposingfactors pages 3-5, bojanovic2022clinicalpresentationscluster pages 4-6) - Serial cultures: up to three may be needed to distinguish colonization/saprophytes from pathogens (review recommendation). (bojanovic2023etiologypredisposingfactors pages 3-5, bojanovic2023etiologypredisposingfactors pages 12-13) - Molecular identification (PCR-based): used in some settings for species/section-level identification, particularly for Aspergillus. (roohi2023otomycosistheforemost pages 5-6)
Diagnostic performance note: In Aspergillus otomycosis, microscopy sensitivity was reported as 90.0% in a single-center series. (bojanovic2022clinicalpresentationscluster pages 4-6)
The retrieved evidence emphasizes that otomycosis can be difficult to distinguish from other etiologies of otitis externa and that mixed bacterial–fungal infections can complicate evaluation, supporting laboratory confirmation where feasible. (bojanovic2023etiologypredisposingfactors pages 3-5)
Otomycosis is typically non-lethal and localized, but it can be recurrent and burdensome. Severe complications are uncommon but include invasive disease (e.g., skull base involvement) particularly in immunocompromised hosts, as highlighted in the 2024 systematic review. (pereira2024topicalantibioticinducedotomycosis pages 1-2)
Relapse risk is supported by the 60-day relapse signal in Aspergillus otomycosis and by review-level statements about recurrence and the need for monitoring. (bojanovic2022clinicalpresentationscluster pages 4-6, bojanovic2023etiologypredisposingfactors pages 5-6)
Core treatment in recent reviews emphasizes: 1. Aural toilet / debridement (microsuction/cleaning of debris). (sangare2021otomycosisinafrica pages 4-5, aloebady2024otomycosisreview pages 3-4) 2. Topical antifungal therapy (imidazoles such as clotrimazole; polyenes such as nystatin; others depending on agent and setting). (sangare2021otomycosisinafrica pages 5-6, bojanovic2023etiologypredisposingfactors pages 5-6) 3. Dry ear precautions and hygiene, and avoidance of ongoing risk factors (e.g., discontinuing topical antibiotics where feasible). (sangare2021otomycosisinafrica pages 3-4, sangare2021otomycosisinafrica pages 4-5)
A pooled analysis of two international multicenter randomized, double-blind, placebo-controlled trials (Feb 2020–Oct 2021) reported: - Therapeutic cure: 68.2% (107/157) clotrimazole vs 25.4% (18/71) placebo (MITT; P<.0001). (j.f.2025pooledanalysisof pages 5-7) - Related adverse events: 2.7% vs 1.5% (clotrimazole vs placebo). (j.f.2025pooledanalysisof pages 1-3)
Notable quote from abstract: “There is no antifungal otic drug for the treatment of otomycosis approved in the United States.” (j.f.2025pooledanalysisof pages 1-3)
Recent/ongoing trials include: - Boric acid vs clotrimazole: NCT04824261 (Assiut University; 1% clotrimazole vs 4% boric acid; enrollment 100; open-label randomized; status uncertain/not yet recruiting per extract). (NCT04824261 chunk 1) - Boric acid in alcohol vs clotrimazole: NCT01547221 (Khon Kaen Hospital; randomized double-masked; n=120; cure at 1 week; completed). (NCT01547221 chunk 1) - Terbinafine: NCT07152327 (single-arm; topical terbinafine cream on ear pack; n=50; not yet recruiting). (NCT07152327 chunk 1) - Investigational topical vs clotrimazole: NCT01993823 (G238 vs clotrimazole; Phase III; completed; results posted). (NCT01993823 chunk 1)
MAXO (actions; suggested): - Ear canal debridement / aural toilet (procedure) - Topical antifungal therapy - Antifungal susceptibility testing - Dry ear precautions / patient education
CHEBI (chemicals; suggested): - Clotrimazole - Miconazole - Nystatin - Terbinafine - Boric acid - Acetic acid
Prevention is largely risk-factor reduction and is supported by both review synthesis and pooled risk-factor evidence: - Avoid EAC trauma from cleaning/instrumentation and reduce unnecessary ototopical antibiotic/steroid use (key pooled factors). (pereira2024topicalantibioticinducedotomycosis pages 1-2) - Keep ears dry, particularly after swimming, and avoid sustained moisture exposure. (roohi2023otomycosistheforemost pages 3-3, sangare2021otomycosisinafrica pages 4-5) - Address underlying comorbidity (e.g., diabetes, immunodeficiency) and avoid practices that damage the EAC barrier or cerumen. (bojanovic2023etiologypredisposingfactors pages 12-13)
No veterinary/natural disease cross-species evidence was identified in the retrieved corpus.
No model organism systems specific to otomycosis pathogenesis were identified in the retrieved corpus.
Key 2023–2024 developments from the retrieved evidence include: 1. Quantified iatrogenic risk (2024 systematic review): pooled estimates implicate ototopical antibiotic exposure, oils/wax solvents, and canal trauma as major drivers. (pereira2024topicalantibioticinducedotomycosis pages 1-2) 2. More granular pathogen profiling: region-specific molecular identification and section/species-level distributions (e.g., Aspergillus section Nigri predominance) support targeted management and surveillance. (roohi2023otomycosistheforemost pages 3-3, roohi2023otomycosistheforemost pages 5-6) 3. Treatment evidence consolidation: continued recognition of heterogeneity and limited head-to-head evidence between topical antifungals and acidifying agents. (yassin2023comparisonofacidifying pages 2-3)
A multi-country summary table of fungi, symptoms, and predisposing factors is compiled in the 2023 Journal of Fungi review (Table 1). (bojanovic2023etiologypredisposingfactors media ef15a2c0, bojanovic2023etiologypredisposingfactors media 195ea1dc, bojanovic2023etiologypredisposingfactors media a1c2fe71, bojanovic2023etiologypredisposingfactors media 7e0923a9)
| Study | Setting/population (incl. n) | Key pathogen distribution | Key risk factors (with % if available) | Key symptoms/clinical findings (with % if available) | Diagnostics used | Treatment/outcomes (cure/response/relapse) | URL/DOI |
|---|---|---|---|---|---|---|---|
| Bojanović 2023, Journal of Fungi | Literature review of global otomycosis evidence; disease-level synthesis, no single cohort n (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 2-3, bojanovic2023etiologypredisposingfactors pages 3-5) | Predominantly Aspergillus and Candida; review notes A. niger complex and Candida spp. as major agents; broader range includes Penicillium, Fusarium, Mucorales, others (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 2-3) | Tropical/subtropical climate; clothing habits; EAC hygiene practices; prolonged antibiotic therapy; diabetes; immunodeficiency; local trauma; occlusive hearing-aid molds (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 2-3) | Common features include itching, otorrhea, ear canal blockage sensation, pain, headache, tinnitus, edema/redness, desquamation, impaired hearing; bilateral disease more common in immunocompromised patients (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 3-5) | History + otoscopy + lab confirmation; KOH/wet mount for screening; culture described as gold standard; serial mycological exams may be needed; molecular identification useful for Aspergillus speciation (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 3-5) | States there are no official therapeutic guidelines; topical polyenes/imidazoles/allylamines used; systemic triazoles reserved for severe forms (bojanovic2023etiologypredisposingfactors pages 1-2, bojanovic2023etiologypredisposingfactors pages 2-3) | https://doi.org/10.3390/jof9060662 |
| Alam 2023, Asian Journal of Medical Sciences | Prospective study of primary otomycosis; 230 clinically diagnosed patients (alam2023astudyof pages 1-2) | Positive fungal growth in 203/230 (88.3%); Aspergillus 185/203 (91.1%), Candida 18/203 (8.9%) (alam2023astudyof pages 1-2) | Most frequent observed risk factor: oil instillation in ear 20%; background risk factors listed: humid climate, ear instrumentation, immunocompromised status, frequent topical antibiotic/steroid use (alam2023astudyof pages 1-2) | Ear itching most common symptom 70.9%; presenting complaints included pain, discharge, hearing difficulty, ringing, heaviness (alam2023astudyof pages 1-2) | Clinical presentation + otoscopic findings; KOH wet mount; culture on Sabouraud dextrose agar; Candida germ tube test; disk diffusion susceptibility testing (alam2023astudyof pages 1-2) | All patients received aural cleaning + topical clotrimazole; 167/203 (83.3%) responded to primary treatment, 36/203 (16.7%) non-responders received topical itraconazole; voriconazole showed highest susceptibility (alam2023astudyof pages 1-2) | https://doi.org/10.3126/ajms.v14i8.54270 |
| Roohi 2023, Mycoses | Molecular/mycological study in north-western Iran; prevalence analysis compared with prior 2013 data; symptom/risk-factor frequencies reported from study cohort (roohi2023otomycosistheforemost pages 3-3, roohi2023otomycosistheforemost pages 4-5, roohi2023otomycosistheforemost pages 5-6) | Aspergillus spp. 89 isolates (88%): section Nigri 58 (57.4%), Flavi 19 (18.8%), Fumigati 12 (11.8%); yeasts 25 isolates incl. Candida parapsilosis 14 (13.8%), C. orthopsilosis 6 (5.9%), C. albicans 5 (4.9%) (roohi2023otomycosistheforemost pages 3-3) | Cotton swab/manipulation 40.6%; topical antibiotics 42.6%; topical steroids 33.7%; prior bacterial otitis 31.7%; swimming 8.6% (roohi2023otomycosistheforemost pages 3-3) | Tinnitus 26.7%; hearing loss 19.8%; scaling 11.8%; previous fungal otitis 27.7%; tympanic membrane perforation 5.9% (roohi2023otomycosistheforemost pages 3-3) | Direct examination, culture, PCR-RFLP / PCR-based molecular identification to species or section level; study notes prevalence rose from 43% (2013) to 50.5% (2021) (roohi2023otomycosistheforemost pages 4-5, roohi2023otomycosistheforemost pages 5-6) | Antifungal susceptibility performed; excerpts note limited in vitro sensitivity to tioconazole and nystatin for some isolates; no direct clinical cure-rate comparison reported in extracted evidence (roohi2023otomycosistheforemost pages 1-2) | https://doi.org/10.1111/myc.13532 |
| Pereira 2024, Indian Journal of Otolaryngology and Head & Neck Surgery | Systematic review of topical antibiotic-induced otomycosis; pooled risk-factor analysis across studies (pereira2024topicalantibioticinducedotomycosis pages 1-2) | Aspergillus most commonly isolated organism (pereira2024topicalantibioticinducedotomycosis pages 1-2) | Ototopical antibiotics ± steroids 47% (95% CI 0.38-0.56); oils/wax solvents 38% (95% CI 0.26-0.51); trauma from cleaning/instrumentation 37% (95% CI 0.21-0.54) (pereira2024topicalantibioticinducedotomycosis pages 1-2) | Symptoms range from pruritus and aural fullness to rare invasive skull-base/cranial nerve involvement (pereira2024topicalantibioticinducedotomycosis pages 1-2) | Review-level synthesis; emphasizes altered ear-canal flora/pH from prolonged topical antibiotics as mechanistic predisposing factor (pereira2024topicalantibioticinducedotomycosis pages 1-2) | Recommends caution with ototopical drops; suggests considering 2% acetic acid in mild cases; no pooled cure-rate estimate extracted (pereira2024topicalantibioticinducedotomycosis pages 1-2) | https://doi.org/10.1007/s12070-024-04852-z |
| Elarabi 2024, Journal of Pure & Applied Sciences | Cross-sectional study in West Libya; 205 clinical samples, 277 fungal isolates recovered (elarabi2024prevalenceandetiology pages 1-2, elarabi2024prevalenceandetiology pages 2-3, elarabi2024prevalenceandetiology pages 3-4) | Fungal growth in 177/205 (86.34%); genus distribution: Aspergillus 229/277 (82.67%), Alternaria 33/277 (11.91%), Candida 9/277 (3.25%), Penicillium 6/277 (2.17%); A. niger 114/277 (41.16%), A. flavus 107/277 (38.63%) (elarabi2024prevalenceandetiology pages 2-3, elarabi2024prevalenceandetiology pages 3-4) | Female sex 62.82%; age 1-20 years 39.35%; reported contributors: diabetes, eczema, immune deficiency, ear cleaning sticks/earphones/oils, water sports, humid/tropical climate (elarabi2024prevalenceandetiology pages 1-2, elarabi2024prevalenceandetiology pages 2-3, elarabi2024prevalenceandetiology pages 3-4) | Hearing loss/weakness, ear blockage, colored secretions, redness/inflammation; itching, ear pain, tinnitus, fullness, swelling also reported (elarabi2024prevalenceandetiology pages 1-2, elarabi2024prevalenceandetiology pages 3-4) | Ear swab culture on Sabouraud dextrose agar and Czapek-Dox agar at 30°C for one week (elarabi2024prevalenceandetiology pages 1-2) | No treatment outcomes reported in extracted evidence (elarabi2024prevalenceandetiology pages 1-2, elarabi2024prevalenceandetiology pages 2-3) | https://doi.org/10.51984/jopas.v23i2.3122 |
| Awungafac 2024, Fortune Journal of Health Sciences | Cross-sectional study in Yaoundé, Cameroon; 100 participants, 50 culture-positive cases (sn2024mycologicepidemiologyand pages 1-2, sn2024mycologicepidemiologyand pages 2-3) | Among cases: Candida albicans 38%, Aspergillus niger 26%, Candida spp. 22%, A. fumigatus 14% (sn2024mycologicepidemiologyand pages 1-2) | Swimming and excessive ear cleaning identified; text also notes humid climate and antibiotic/steroid abuse as contributing factors (sn2024mycologicepidemiologyand pages 1-2, sn2024mycologicepidemiologyand pages 2-3) | Complications/findings noted include hearing loss, tympanic membrane perforation, invasive temporal bone infection; female cases 58% (29/50) (sn2024mycologicepidemiologyand pages 1-2, sn2024mycologicepidemiologyand pages 2-3) | Culture on Sabouraud-chloramphenicol agar; microscopy; germ tube test for yeast/C. albicans; disk and macrodilution susceptibility testing (sn2024mycologicepidemiologyand pages 1-2, sn2024mycologicepidemiologyand pages 2-3) | Nystatin showed highest sensitivity, 86% of isolates susceptible; no clinical cure-rate reported in extracted evidence (sn2024mycologicepidemiologyand pages 1-2) | https://doi.org/10.26502/fjhs.162 |
| Bojanović 2022, Journal of Fungi | Single-center retrospective/pilot study of laboratory-confirmed Aspergillus otomycosis; 30 patients with follow-up at 30 and 60 days (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6, bojanovic2022clinicalpresentationscluster pages 2-4) | A. niger complex 66.7%, A. flavus complex 33.3% (bojanovic2022clinicalpresentationscluster pages 2-4) | Not a risk-factor prevalence study; focused on relapse and biofilm in Aspergillus otomycosis (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6) | At 30 days all mycology negative, but 33.3% still had low-to-moderate symptoms; relapse at 60 days in 6/30 (~20%) with same species re-isolated (bojanovic2022clinicalpresentationscluster pages 4-6) | Microscopy sensitivity 90%; wet mount rapid/cost-effective; culture at both routine and mold-favoring temperatures; 16.7% of isolates required 27-28°C for growth (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6) | Relapse in 6/30 by day 60; all relapse isolates produced biofilm, supporting a role in persistence/recurrence (bojanovic2022clinicalpresentationscluster pages 1-2, bojanovic2022clinicalpresentationscluster pages 4-6) | https://doi.org/10.3390/jof8030315 |
| Ansley 2025, Journal of Otolaryngology - Head & Neck Surgery | Pooled analysis of 2 international multicenter randomized double-blind placebo-controlled trials (CLEAR-1/CLEAR-2); 393 treated, 228 MITT (157 clotrimazole, 71 placebo) (j.f.2025pooledanalysisof pages 1-3, j.f.2025pooledanalysisof pages 3-4) | Common pathogens Aspergillus and Candida; efficacy analysis restricted to baseline culture-positive patients (j.f.2025pooledanalysisof pages 1-3, j.f.2025pooledanalysisof pages 3-4) | Trial excluded diabetes/immunosuppression, tympanic perforation, recent antifungals/corticosteroids, bacterial/malignant otitis externa (j.f.2025pooledanalysisof pages 3-4) | Symptoms assessed: pruritus, otalgia, otorrhea, ear fullness, scored 0-3 (j.f.2025pooledanalysisof pages 1-3, j.f.2025pooledanalysisof pages 3-4) | Ear exudate for mycological/microbiological evaluation; primary endpoint = therapeutic cure (mycological + clinical) at day 24-26 (j.f.2025pooledanalysisof pages 1-3, j.f.2025pooledanalysisof pages 3-4) | Clotrimazole 1% otic solution superior to placebo: therapeutic cure 68.2% vs 25.4%; mycological cure 73.9% vs 28.2%; related AEs 2.7% vs 1.5%; treatment safe/well tolerated (j.f.2025pooledanalysisof pages 5-7, j.f.2025pooledanalysisof pages 1-3) | https://doi.org/10.1177/19160216251330629 |
| Yassin 2023, Current Medical Mycology | Mini-review comparing acidifying agents and clotrimazole; 11 studies included from 53 records screened (yassin2023comparisonofacidifying pages 2-3, yassin2023comparisonofacidifying pages 1-2) | Review-level summary of otomycosis pathogens rather than new microbiology; evaluates therapy classes incl. clotrimazole, nystatin, miconazole, acidifying agents (yassin2023comparisonofacidifying pages 1-2) | Not a primary epidemiologic study; notes recurrent disease common and sparse direct head-to-head evidence (yassin2023comparisonofacidifying pages 2-3) | Focuses on symptom improvement (pain, itching, swelling, hearing loss) rather than symptom prevalence (yassin2023comparisonofacidifying pages 1-2) | Review synthesis of prior studies; no new diagnostic cohort (yassin2023comparisonofacidifying pages 2-3, yassin2023comparisonofacidifying pages 1-2) | Eight studies favored clotrimazole for symptom relief; evidence heterogeneous, low quality, and adverse events poorly reported; authors conclude evidence is insufficient to definitively choose clotrimazole vs acidifying agents (yassin2023comparisonofacidifying pages 2-3, yassin2023comparisonofacidifying pages 1-2) | https://doi.org/10.18502/cmm.2023.345035.1402 |
| Nazari 2025, BMC Infectious Diseases | Systematic review/meta-analysis of molecularly identified otomycosis isolates; 20 studies, 1392 fungal isolates (abstract-level evidence from search results) (bojanovic2023etiologypredisposingfactors pages 1-2) | Prevalence among clinically suspected patients 58.3% (95% CI 41.4-73.5%); Aspergillus 75.8% (95% CI 70.3-80.6%), Candida 15.3% (95% CI 8.7-25.6%); frequent species A. niger 30.9%, A. tubingensis 23.7%, C. parapsilosis 39.7% of Candida isolates, C. albicans 30.8% (bojanovic2023etiologypredisposingfactors pages 1-2) | Not a primary risk-factor study; focused on molecular distribution of causative agents (bojanovic2023etiologypredisposingfactors pages 1-2) | Not reported in extracted evidence (bojanovic2023etiologypredisposingfactors pages 1-2) | Inclusion required molecular identification methods; addresses limits of conventional morphology (bojanovic2023etiologypredisposingfactors pages 1-2) | No treatment outcomes; authors state evidence quality poor across included studies (bojanovic2023etiologypredisposingfactors pages 1-2) | https://doi.org/10.1186/s12879-025-10954-y |
| NCT04824261, Assiut University | Randomized open-label parallel trial planned; 100 patients, 50/arm; status listed as UNKNOWN / not yet recruiting in registry extract (NCT04824261 chunk 1) | Trial rationale cites common pathogens Candida and Aspergillus (NCT04824261 chunk 1) | High recurrence noted as rationale; no baseline risk-factor estimates (NCT04824261 chunk 1) | Symptomatic otomycosis with microscopic and/or culture confirmation required (NCT04824261 chunk 1) | Microscopy and/or culture confirmation; follow-up at 1 week, 2 weeks, 1 month (NCT04824261 chunk 1) | Compares 1% clotrimazole solution vs 4% boric acid in distilled water; primary outcome curative rate at 1 month (results not yet available in extract) (NCT04824261 chunk 1) | https://clinicaltrials.gov/study/NCT04824261 |
| NCT01547221, Khon Kaen Hospital | Randomized double-masked parallel completed trial; n=120 (NCT01547221 chunk 1) | Not a pathogen-distribution study; eligibility required KOH-positive otomycosis (NCT01547221 chunk 1) | No baseline risk-factor estimates in registry extract (NCT01547221 chunk 1) | Symptomatic otomycosis; age >7 years (NCT01547221 chunk 1) | Otolaryngologist microscopic findings at 1 week; KOH smear positive at baseline (NCT01547221 chunk 1) | Compared single application 1% clotrimazole ear drop vs 3% boric acid in 70% alcohol; primary outcome cure rate at 1 week; adverse effects recorded 5 minutes after application (results not included in extract) (NCT01547221 chunk 1) | https://clinicaltrials.gov/study/NCT01547221 |
| NCT07152327, Assiut University | Single-arm open-label interventional study; planned n=50 adults; not yet recruiting (NCT07152327 chunk 1) | Study rationale cites in vitro activity of terbinafine against Aspergillus and Candida (NCT07152327 chunk 1) | Excludes mixed infections, immunocompromise, perforation, recent antifungals, pregnancy/breastfeeding (NCT07152327 chunk 1) | Clinical otoscopic exam plus baseline and post-treatment ear swabs planned (NCT07152327 chunk 1) | Baseline/post-treatment KOH and culture; otoscopy (NCT07152327 chunk 1) | Tests terbinafine 1% cream on ear pack changed every 2 days for 14 days; primary outcome combined clinical + mycological cure at 14 days (results pending) (NCT07152327 chunk 1) | https://clinicaltrials.gov/study/NCT07152327 |
Table: This table compiles key 2023-2025 otomycosis evidence, including major pathogens, risk factors, clinical features, diagnostics, and treatment outcomes from reviews, cohort studies, randomized trials, and registry entries. It is useful for quickly comparing real-world epidemiology and management evidence across studies.
References
(bojanovic2023etiologypredisposingfactors pages 1-2): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(alam2023astudyof pages 1-2): Imran Alam, Rajeev Krishna Gupta, Anuja Bhargava, S M Faiz, Saurabh Srivastava, Fareya Haider, Abhijeet Singh, and Himanshu Sharma. A study of clinico-mycological profile and treatment of primary otomycosis. Asian Journal of Medical Sciences, 14:133-138, Aug 2023. URL: https://doi.org/10.3126/ajms.v14i8.54270, doi:10.3126/ajms.v14i8.54270. This article has 2 citations.
(j.f.2025pooledanalysisof pages 1-3): Ansley J.F., Bernal-Sprekelsen M., Butehorn H.F., Todorov S., Tzvetkov V., Douglis F., Georgiev K., and Moreira da Silva F. Pooled analysis of 2 randomized clinical trials to evaluate the efficacy and safety of clotrimazole 1% otic solution for the treatment of otomycosis in adults. Journal of Otolaryngology - Head & Neck Surgery, Apr 2025. URL: https://doi.org/10.1177/19160216251330629, doi:10.1177/19160216251330629. This article has 2 citations.
(roohi2023otomycosistheforemost pages 3-3): Behrad Roohi, Shadman Nemati, Abbas Alipour, Leila Faeli, Sabah Mayahi, Iman Haghani, Makan Shalchizadeh, Ali Darini, Abdullah M. S. Al‐Hatmi, Mahdi Abastabar, and Tahereh Shokohi. Otomycosis: the foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in north‐western iran. Mycoses, 66:87-97, Sep 2023. URL: https://doi.org/10.1111/myc.13532, doi:10.1111/myc.13532. This article has 26 citations and is from a peer-reviewed journal.
(sn2024mycologicepidemiologyand pages 1-2): Awungafac Sn, Ngando Ml, Akem Et, Tolefac Pn, and Ndjolo A. Mycologic epidemiology and antifungal susceptibility patterns of otomycosis in yaounde, cameroon: a cross sectional study revealing candida albicans dorminance and nystatin sensitivity. Fortune Journal of Health Sciences, Jan 2024. URL: https://doi.org/10.26502/fjhs.162, doi:10.26502/fjhs.162. This article has 1 citations.
(sangare2021otomycosisinafrica pages 4-5): Ibrahim Sangaré, Fructueux Modeste Amona, Richard Wend-Lasida Ouedraogo, Adama Zida, and Macaire Sampawende Ouedraogo. Otomycosis in africa: epidemiology, diagnosis and treatment. Journal of Medical Mycology, 31:101115, Jun 2021. URL: https://doi.org/10.1016/j.mycmed.2021.101115, doi:10.1016/j.mycmed.2021.101115. This article has 34 citations and is from a peer-reviewed journal.
(pereira2024topicalantibioticinducedotomycosis pages 1-2): Maria Pereira, Karthik Rao, Florida Sharin, Faiz Tanweer, Manish Mair, and Peter Rea. Topical antibiotic-induced otomycosis - a systematic review of aetiology and risk factors. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 76 5:3766-3776, Jul 2024. URL: https://doi.org/10.1007/s12070-024-04852-z, doi:10.1007/s12070-024-04852-z. This article has 4 citations.
(NCT01547221 chunk 1): Ms. Sarisa Romsaithong. Effectiveness of 3% Boric Acid in 70% Alcohol Versus 1% Clotrimazole Solution in Otomycosis Patients. Khon Kaen Hospital. 2012. ClinicalTrials.gov Identifier: NCT01547221
(elarabi2024prevalenceandetiology pages 2-3): Ali Elarabi, Adel Jama, Monira AL-Gorag, Laila Gewili, and Maha Farid. Prevalence and etiology of otomycosis in west libya. Journal of Pure & Applied Sciences, 23:144-148, Nov 2024. URL: https://doi.org/10.51984/jopas.v23i2.3122, doi:10.51984/jopas.v23i2.3122. This article has 2 citations.
(elarabi2024prevalenceandetiology pages 3-4): Ali Elarabi, Adel Jama, Monira AL-Gorag, Laila Gewili, and Maha Farid. Prevalence and etiology of otomycosis in west libya. Journal of Pure & Applied Sciences, 23:144-148, Nov 2024. URL: https://doi.org/10.51984/jopas.v23i2.3122, doi:10.51984/jopas.v23i2.3122. This article has 2 citations.
(bojanovic2023etiologypredisposingfactors pages 2-3): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(bojanovic2023etiologypredisposingfactors pages 3-5): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(roohi2023otomycosistheforemost pages 5-6): Behrad Roohi, Shadman Nemati, Abbas Alipour, Leila Faeli, Sabah Mayahi, Iman Haghani, Makan Shalchizadeh, Ali Darini, Abdullah M. S. Al‐Hatmi, Mahdi Abastabar, and Tahereh Shokohi. Otomycosis: the foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in north‐western iran. Mycoses, 66:87-97, Sep 2023. URL: https://doi.org/10.1111/myc.13532, doi:10.1111/myc.13532. This article has 26 citations and is from a peer-reviewed journal.
(roohi2023otomycosistheforemost pages 4-5): Behrad Roohi, Shadman Nemati, Abbas Alipour, Leila Faeli, Sabah Mayahi, Iman Haghani, Makan Shalchizadeh, Ali Darini, Abdullah M. S. Al‐Hatmi, Mahdi Abastabar, and Tahereh Shokohi. Otomycosis: the foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in north‐western iran. Mycoses, 66:87-97, Sep 2023. URL: https://doi.org/10.1111/myc.13532, doi:10.1111/myc.13532. This article has 26 citations and is from a peer-reviewed journal.
(bojanovic2022clinicalpresentationscluster pages 4-6): Mila Bojanović, Aleksandra Ignjatović, Marko Stalević, Valentina Arsić-Arsenijević, Marina Ranđelović, Vladimir Gerginić, Zorica Stojanović-Radić, Ognjen Stojković, Emilija Živković-Marinkov, and Suzana Otašević. Clinical presentations, cluster analysis and laboratory-based investigation of aspergillus otomycosis—a single center experience. Journal of Fungi, 8:315, Mar 2022. URL: https://doi.org/10.3390/jof8030315, doi:10.3390/jof8030315. This article has 21 citations.
(bojanovic2022clinicalpresentationscluster pages 1-2): Mila Bojanović, Aleksandra Ignjatović, Marko Stalević, Valentina Arsić-Arsenijević, Marina Ranđelović, Vladimir Gerginić, Zorica Stojanović-Radić, Ognjen Stojković, Emilija Živković-Marinkov, and Suzana Otašević. Clinical presentations, cluster analysis and laboratory-based investigation of aspergillus otomycosis—a single center experience. Journal of Fungi, 8:315, Mar 2022. URL: https://doi.org/10.3390/jof8030315, doi:10.3390/jof8030315. This article has 21 citations.
(sn2024mycologicepidemiologyand pages 2-3): Awungafac Sn, Ngando Ml, Akem Et, Tolefac Pn, and Ndjolo A. Mycologic epidemiology and antifungal susceptibility patterns of otomycosis in yaounde, cameroon: a cross sectional study revealing candida albicans dorminance and nystatin sensitivity. Fortune Journal of Health Sciences, Jan 2024. URL: https://doi.org/10.26502/fjhs.162, doi:10.26502/fjhs.162. This article has 1 citations.
(bojanovic2023etiologypredisposingfactors pages 12-13): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(bojanovic2023etiologypredisposingfactors pages 5-6): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(aloebady2024otomycosisreview pages 3-4): Mouna Akeel Hamed Al-Oebady, Hawraa F. Wali, and Nuha Mohammed Mousa. Otomycosis, review. Scholars Academic Journal of Biosciences, 12:236-242, Sep 2024. URL: https://doi.org/10.36347/sajb.2024.v12i08.001, doi:10.36347/sajb.2024.v12i08.001. This article has 2 citations.
(sangare2021otomycosisinafrica pages 5-6): Ibrahim Sangaré, Fructueux Modeste Amona, Richard Wend-Lasida Ouedraogo, Adama Zida, and Macaire Sampawende Ouedraogo. Otomycosis in africa: epidemiology, diagnosis and treatment. Journal of Medical Mycology, 31:101115, Jun 2021. URL: https://doi.org/10.1016/j.mycmed.2021.101115, doi:10.1016/j.mycmed.2021.101115. This article has 34 citations and is from a peer-reviewed journal.
(sangare2021otomycosisinafrica pages 3-4): Ibrahim Sangaré, Fructueux Modeste Amona, Richard Wend-Lasida Ouedraogo, Adama Zida, and Macaire Sampawende Ouedraogo. Otomycosis in africa: epidemiology, diagnosis and treatment. Journal of Medical Mycology, 31:101115, Jun 2021. URL: https://doi.org/10.1016/j.mycmed.2021.101115, doi:10.1016/j.mycmed.2021.101115. This article has 34 citations and is from a peer-reviewed journal.
(j.f.2025pooledanalysisof pages 5-7): Ansley J.F., Bernal-Sprekelsen M., Butehorn H.F., Todorov S., Tzvetkov V., Douglis F., Georgiev K., and Moreira da Silva F. Pooled analysis of 2 randomized clinical trials to evaluate the efficacy and safety of clotrimazole 1% otic solution for the treatment of otomycosis in adults. Journal of Otolaryngology - Head & Neck Surgery, Apr 2025. URL: https://doi.org/10.1177/19160216251330629, doi:10.1177/19160216251330629. This article has 2 citations.
(roohi2023otomycosistheforemost pages 1-2): Behrad Roohi, Shadman Nemati, Abbas Alipour, Leila Faeli, Sabah Mayahi, Iman Haghani, Makan Shalchizadeh, Ali Darini, Abdullah M. S. Al‐Hatmi, Mahdi Abastabar, and Tahereh Shokohi. Otomycosis: the foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in north‐western iran. Mycoses, 66:87-97, Sep 2023. URL: https://doi.org/10.1111/myc.13532, doi:10.1111/myc.13532. This article has 26 citations and is from a peer-reviewed journal.
(NCT04824261 chunk 1): Maria Hosny Kamal Gendi. Effectiveness of 4% Boric Acid in Distilled Water Versus Clotrimazole Solution in Otomycosis Patients.. Assiut University. 2021. ClinicalTrials.gov Identifier: NCT04824261
(NCT07152327 chunk 1): Doaa Mohamed Samy Mohamed Abd Ellatief. Terbinafine Hydrochloride for the Treatment of Otomycosis. Assiut University. 2025. ClinicalTrials.gov Identifier: NCT07152327
(NCT01993823 chunk 1): Clinical Study to Assess the Efficacy and Safety of G238 Compared to Clotrimazole Otic Solution in the Treatment of Otomycosis. Salvat. 2013. ClinicalTrials.gov Identifier: NCT01993823
(yassin2023comparisonofacidifying pages 2-3): Zeynab Yassin, Behrooz Amirzargar, R. Ghasemi, Farnaz Valizadeh, and M. Fattahi. Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review. Current Medical Mycology, 9:45-51, Jun 2023. URL: https://doi.org/10.18502/cmm.2023.345035.1402, doi:10.18502/cmm.2023.345035.1402. This article has 6 citations.
(bojanovic2023etiologypredisposingfactors media ef15a2c0): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(bojanovic2023etiologypredisposingfactors media 195ea1dc): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(bojanovic2023etiologypredisposingfactors media a1c2fe71): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(bojanovic2023etiologypredisposingfactors media 7e0923a9): Mila Bojanović, Marko Stalević, Valentina Arsić-Arsenijević, Aleksandra Ignjatović, Marina Ranđelović, Milan Golubović, Emilija Živković-Marinkov, Goran Koraćević, Bojana Stamenković, and Suzana Otašević. Etiology, predisposing factors, clinical features and diagnostic procedure of otomycosis: a literature review. Journal of Fungi, 9:662, Jun 2023. URL: https://doi.org/10.3390/jof9060662, doi:10.3390/jof9060662. This article has 42 citations.
(elarabi2024prevalenceandetiology pages 1-2): Ali Elarabi, Adel Jama, Monira AL-Gorag, Laila Gewili, and Maha Farid. Prevalence and etiology of otomycosis in west libya. Journal of Pure & Applied Sciences, 23:144-148, Nov 2024. URL: https://doi.org/10.51984/jopas.v23i2.3122, doi:10.51984/jopas.v23i2.3122. This article has 2 citations.
(bojanovic2022clinicalpresentationscluster pages 2-4): Mila Bojanović, Aleksandra Ignjatović, Marko Stalević, Valentina Arsić-Arsenijević, Marina Ranđelović, Vladimir Gerginić, Zorica Stojanović-Radić, Ognjen Stojković, Emilija Živković-Marinkov, and Suzana Otašević. Clinical presentations, cluster analysis and laboratory-based investigation of aspergillus otomycosis—a single center experience. Journal of Fungi, 8:315, Mar 2022. URL: https://doi.org/10.3390/jof8030315, doi:10.3390/jof8030315. This article has 21 citations.
(j.f.2025pooledanalysisof pages 3-4): Ansley J.F., Bernal-Sprekelsen M., Butehorn H.F., Todorov S., Tzvetkov V., Douglis F., Georgiev K., and Moreira da Silva F. Pooled analysis of 2 randomized clinical trials to evaluate the efficacy and safety of clotrimazole 1% otic solution for the treatment of otomycosis in adults. Journal of Otolaryngology - Head & Neck Surgery, Apr 2025. URL: https://doi.org/10.1177/19160216251330629, doi:10.1177/19160216251330629. This article has 2 citations.
(yassin2023comparisonofacidifying pages 1-2): Zeynab Yassin, Behrooz Amirzargar, R. Ghasemi, Farnaz Valizadeh, and M. Fattahi. Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review. Current Medical Mycology, 9:45-51, Jun 2023. URL: https://doi.org/10.18502/cmm.2023.345035.1402, doi:10.18502/cmm.2023.345035.1402. This article has 6 citations.
name: Otomycosis
creation_date: "2026-02-16T00:00:00Z"
updated_date: "2026-04-11T01:06:52Z"
category: Infectious
description: >
Otomycosis is a superficial fungal infection of the external auditory canal,
commonly caused by Aspergillus and Candida species. It accounts for approximately
5-25% of otitis externa cases worldwide, with higher prevalence in tropical and
subtropical climates. Predisposing factors include prior antibiotic or steroid
ear drop use, trauma from ear cleaning, and humid environments. Clinical features
include pruritus, otalgia, otorrhea, and conductive hearing loss due to fungal
debris obstructing the ear canal. Otomycosis is increasingly recognized as a
biofilm-related infection, which contributes to treatment failure and recurrence.
Management centers on thorough aural toilet followed by topical antifungal agents.
disease_term:
preferred_term: otomycosis
term:
id: MONDO:0000262
label: otomycosis
parents:
- Otitis externa
- Fungal infection
infectious_agent:
- name: Aspergillus species
infectious_agent_term:
preferred_term: Aspergillus
term:
id: NCBITaxon:5052
label: Aspergillus
description: >
Aspergillus species are the most common causative agents of otomycosis
worldwide. In a large Chinese series of 452 cases, A. terreus was the most
common (62.83%), followed by A. flavus (20.35%) and A. niger (12.17%).
In other geographic regions, A. niger predominates. Species-level
identification is important because antifungal susceptibility varies
significantly between species, with approximately 30% resistance to
topical azoles (bifonazole and clotrimazole) reported for Aspergillus
isolates. Azole resistance mechanisms include cyp51A mutations and
overexpression of efflux pump genes (mdr1, mfs) in Aspergillus section
Nigri.
evidence:
- reference: PMID:38578519
reference_title: "Pathogenic Aspergillus Strains Identification and Antifungal Susceptibility Analysis of 452 Cases with Otomycosis in Jingzhou, China."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "In the 452 clinical strains isolated from the external ear canal, 284 were identified as Aspergillus terreus (62.83%), 92 as Aspergillus flavus (20.35%), 55 as Aspergillus niger (12.17%)."
explanation: Large clinical series identifying Aspergillus species distribution in otomycosis, with A. terreus as the most common in central China.
- reference: PMID:40317309
reference_title: "Ear-canal lavage for curing noninvasive otomycosis: A randomized controlled trial."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Our fungal culture results revealed that, in 83 patients (84.69%), the otomycotic pathogen was Aspergillus"
explanation: RCT confirming Aspergillus as the dominant pathogen in 84.69% of culture-positive otomycosis cases.
- reference: PMID:38486086
reference_title: "cyp51A mutations, protein modeling, and efflux pump gene expression reveals multifactorial complexity towards understanding Aspergillus section Nigri azole resistance mechanism."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "Black Aspergillus species are the most common etiological agents of otomycosis, and pulmonary aspergillosis."
explanation: Study on azole resistance mechanisms in Aspergillus section Nigri, confirming black aspergilli as the most common otomycosis agents.
- reference: PMID:37257666
reference_title: "Aspergillus welwitschiae; an otomycosis predominant agent, new epidemiological and antifungal susceptibility data from Iran."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Black aspergilli (section Nigri) are predominate etiologic agents of otomycosis, however, there is controversy in the exact differentiation of species."
explanation: Molecular study using calmodulin gene sequencing revealing A. welwitschiae (60.5%) and A. tubingensis (36.0%) as the true predominant species within section Nigri, rather than A. niger sensu stricto.
- reference: PMID:37108955
reference_title: "Diagnosis and Treatment of Invasive Aspergillosis Caused by Non-fumigatus Aspergillus spp."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "A. niger is more frequently reported in less severe infections such as otomycosis."
explanation: Comprehensive review of non-fumigatus Aspergillus noting A. niger's association with otomycosis as a less severe infection compared to invasive aspergillosis.
- name: Candida species
infectious_agent_term:
preferred_term: Candida
term:
id: NCBITaxon:5475
label: Candida
description: >
Candida species are the second most common causative agents of otomycosis,
accounting for a smaller proportion of cases than Aspergillus. C. parapsilosis
and C. tropicalis are the most frequently isolated Candida species. Candida
otomycosis may present with a creamy white discharge rather than the dark
fungal debris typical of Aspergillus infection. Co-infection with bacteria
(particularly Staphylococcus) is commonly observed.
evidence:
- reference: PMID:38450054
reference_title: "Study on the microbial diversity of ear canal secretions from patients with otomycosis."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Aspergillus spp. (average abundance 90.68%) was the dominant fungus involved in otomycosis secretion."
explanation: Microbiome study showing fungal community composition in otomycosis, with Aspergillus dominant and Candida as a secondary pathogen.
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "common fungal isolate was Aspergillus niger 9 (45.0%)."
explanation: Clinical study from Nigeria identifying Aspergillus niger as the most common isolate, with Candida species also identified among causative agents.
- reference: PMID:37367594
reference_title: "Clonal Diversity of Candida auris, Candida blankii, and Kodamaea ohmeri Isolated from Septicemia and Otomycosis in Bangladesh as Determined by Multilocus Sequence Typing."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Candida auris, Candida blankii, and Kodamaea ohmeri have been regarded as emerging fungal pathogens that can cause infections with high mortality."
explanation: Molecular typing study identifying emerging Candida species (including C. auris with azole resistance-associated ERG11p Y132F substitution) isolated from otomycosis in Bangladesh.
- reference: PMID:37223402
reference_title: "Nanocrystalline Silver for the Treatment of Otomycosis: A Retrospective Study."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Commonly found fungi belonging to the genus Aspergillus (55%), followed by Candida (45%)."
explanation: Clinical study showing Candida as the second most common pathogen (45%) after Aspergillus (55%) in otomycosis.
prevalence:
- population: Global
notes: >
Otomycosis accounts for 5-20% of otitis externa cases worldwide, with
higher prevalence in tropical and subtropical regions. A 2024 systematic
review found the condition is most commonly reported in tropical and
sub-tropical countries.
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is a chronic or subacute fungal infection of external ear accounting to 5 to 20% of external ear infection worldwide."
explanation: Systematic review establishing otomycosis as 5-20% of all otitis externa cases.
pathophysiology:
- name: Disruption of cerumen antimicrobial barrier
description: >
The external auditory canal is normally protected by cerumen, which maintains
an acidic pH (mean ~3.95), contains antimicrobial peptides (defensins hBD1-3,
cathelicidin LL-37, lysozyme, lactoferrin, BPI), and supports colonization
resistance by resident microbiota. Physical or chemical disruption of this
barrier by excessive ear cleaning, moisture exposure, or other trauma
removes the primary antimicrobial defense.
cell_types:
- preferred_term: Epithelial cell of external acoustic meatus
term:
id: CL:1000434
label: epithelial cell of external acoustic meatus
biological_processes:
- preferred_term: Antimicrobial humoral response
modifier: DECREASED
term:
id: GO:0019730
label: antimicrobial humoral response
locations:
- preferred_term: External acoustic meatus
term:
id: UBERON:0001352
label: external acoustic meatus
downstream:
- target: Antibiotic-induced dysbiosis of ear canal microbiota
description: Loss of cerumen barrier combined with antibiotic exposure disrupts commensal flora.
evidence:
- reference: PMID:41596275
reference_title: "The Importance of Ear Canal Microbiota and Earwax in the Prevention of Outer Ear Infections."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Both an excess and a deficiency of earwax can lead to dysbiosis of the outer ear, and consequently to the development of various infections."
explanation: Links cerumen disruption to dysbiosis and subsequent ear infections.
evidence:
- reference: PMID:21298458
reference_title: "Human antimicrobial proteins in ear wax."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "All ten antimicrobial peptides are present in ear wax. Some of these proteins seem to be merelycell-bound in ear wax. Antimicrobial peptides in ear wax prevent bacteria and fungi from causing infections inthe external auditory canal."
explanation: Identifies antimicrobial peptides in cerumen that protect the EAC from fungal infection.
- reference: PMID:41596275
reference_title: "The Importance of Ear Canal Microbiota and Earwax in the Prevention of Outer Ear Infections."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Earwax is composed primarily of keratin secreted by epithelial cells and substances secreted by sweat and apocrine glands. It plays a key role in the physiology of the ear canal, maintaining a low pH, limiting moisture, and exhibiting antimicrobial properties."
explanation: Confirms cerumen's antimicrobial role through low pH and antimicrobial properties.
- name: Antibiotic-induced dysbiosis of ear canal microbiota
description: >
Ototopical antibiotic use is the most common predisposing factor for
otomycosis, found in approximately 47% of cases. Antibiotics suppress
commensal bacteria that normally compete with fungi for nutrients and
ecological niches, creating a permissive environment for fungal overgrowth.
The resulting dysbiosis shifts the microbial community from
bacterial-dominated to fungal-dominated.
biological_processes:
- preferred_term: Antimicrobial humoral response
modifier: DECREASED
term:
id: GO:0019730
label: antimicrobial humoral response
downstream:
- target: Fungal colonization of the external auditory canal
description: Loss of bacterial colonization resistance permits Aspergillus and Candida to establish infection.
evidence:
- reference: PMID:41596275
reference_title: "The Importance of Ear Canal Microbiota and Earwax in the Prevention of Outer Ear Infections."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "The natural ear canal microbiota provides so-called colonization resistance, which protects against invasion by pathogenic microorganisms."
explanation: Establishes that normal microbiota provides colonization resistance against pathogens.
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Aspergillus was the most common species isolated."
explanation: Systematic review identifying Aspergillus as the most common pathogen in otomycosis, with ototopical antibiotics as the commonest predisposing factor.
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "50.0% applied ototopic medications before presentation"
explanation: Clinical study documenting prior ototopical medication use as a predisposing factor in half of patients.
- reference: PMID:38450054
reference_title: "Study on the microbial diversity of ear canal secretions from patients with otomycosis."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Staphylococcus spp. (average abundance 29.05%) was the dominant bacteria and Aspergillus spp. (average abundance 90.68%) was the dominant fungus involved in otomycosis secretion."
explanation: Microbiome study demonstrating the dysbiotic shift in otomycosis, with Aspergillus dominating the fungal community and bacterial co-infection by Staphylococcus.
- name: Fungal colonization of the external auditory canal
description: >
Aspergillus and Candida species colonize the external auditory canal when
the microenvironment becomes permissive. Aspergillus species (particularly
A. niger and A. flavus) are the most commonly isolated pathogens, followed
by Candida species (particularly C. parapsilosis and C. tropicalis). The
species distribution varies by geographic region.
locations:
- preferred_term: External acoustic meatus
term:
id: UBERON:0001352
label: external acoustic meatus
downstream:
- target: Biofilm formation and antifungal resistance
description: Colonizing fungi develop biofilm structures that provide structural protection and drug resistance.
evidence:
- reference: PMID:36080191
reference_title: "Poly-(lactic-co-glycolic) Acid Nanoparticles Entrapping Pterostilbene for Targeting Aspergillus Section Nigri."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "The Aspergillus section Nigri causes otomycosis localized in the external auditory canal."
explanation: Establishes Aspergillus section Nigri as a cause of otomycosis leading to biofilm formation.
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Aspergillus was the most common species isolated."
explanation: Systematic review confirming Aspergillus as the predominant causative agent.
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "common fungal isolate was Aspergillus niger 9 (45.0%)."
explanation: Clinical study confirming A. niger as the most common fungal isolate.
- name: Biofilm formation and antifungal resistance
description: >
Colonizing fungi form biofilms on the ear canal epithelium. The biofilm
extracellular matrix acts as a diffusion barrier that reduces antifungal
drug penetration and mediates phenotypic drug resistance. This biofilm-mediated
resistance contributes to treatment failure and recurrence rates of
approximately 15%.
biological_processes:
- preferred_term: Biofilm formation
modifier: INCREASED
term:
id: GO:0042710
label: biofilm formation
downstream:
- target: Local innate immune activation
description: Biofilm persistence and fungal biomass accumulation provoke host inflammatory response.
evidence:
- reference: PMID:36080191
reference_title: "Poly-(lactic-co-glycolic) Acid Nanoparticles Entrapping Pterostilbene for Targeting Aspergillus Section Nigri."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "the PLGA-NPs system can increase the bioavailability of PTB in Aspergillus section Nigri biofilm by overcoming the biofilm matrix barrier and delivering PTB to fungal cells."
explanation: Demonstrates that biofilm matrix acts as a barrier, confirming biofilm persistence leads to continued host exposure.
evidence:
- reference: PMID:36080191
reference_title: "Poly-(lactic-co-glycolic) Acid Nanoparticles Entrapping Pterostilbene for Targeting Aspergillus Section Nigri."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "the PLGA-NPs system can increase the bioavailability of PTB in Aspergillus section Nigri biofilm by overcoming the biofilm matrix barrier and delivering PTB to fungal cells."
explanation: Demonstrates that Aspergillus biofilm matrix acts as a barrier to antifungal agents, necessitating nanoparticle delivery to penetrate it.
- reference: PMID:36632528
reference_title: "Relapsing Aspergillus otomycosis despite prolonged systemic antifungal therapy and resolution after topical voriconazole administration: A case report."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "otomycosis relapsed even after six months of continuous systemic antifungal treatment with therapeutic drug levels and without treatment interruption; and only resolved after application of topical voriconazole"
explanation: Case report demonstrating that biofilm-mediated resistance can cause otomycosis relapse despite prolonged systemic therapy, supporting the clinical significance of biofilm as a treatment barrier.
- name: Local innate immune activation
description: >
Fungal hyphae, spores, and biofilm debris provoke local innate immune
activation in the external auditory canal. Neutrophils and other innate
immune cells are recruited to the site, producing inflammatory mediators
that cause tissue edema, erythema, and pain. The host defense response
to fungus is activated but insufficient to clear the biofilm-protected
infection.
biological_processes:
- preferred_term: Defense response to fungus
modifier: INCREASED
term:
id: GO:0050832
label: defense response to fungus
cell_types:
- preferred_term: Neutrophil
term:
id: CL:0000775
label: neutrophil
downstream:
- target: Canal obstruction and symptom manifestation
description: Inflammatory exudate combines with fungal biomass to obstruct the ear canal.
evidence:
- reference: PMID:21298458
reference_title: "Human antimicrobial proteins in ear wax."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "If this local defence system fails, infections of the external auditory canal may result."
explanation: Failure of local defense leads to progressive EAC infection and inflammatory consequences.
evidence:
- reference: PMID:21298458
reference_title: "Human antimicrobial proteins in ear wax."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "If this local defence system fails, infections of the external auditory canal may result."
explanation: Failure of the cerumen antimicrobial defense system leads to EAC infections with consequent inflammation.
- name: Canal obstruction and symptom manifestation
description: >
The combination of fungal biomass (hyphae, spores, conidiophores),
inflammatory exudate, and desquamated epithelium accumulates in the
external auditory canal, producing the characteristic clinical symptoms
of pruritus, otalgia, discharge, and conductive hearing impairment. The
degree of obstruction correlates with the severity of hearing loss.
locations:
- preferred_term: External acoustic meatus
term:
id: UBERON:0001352
label: external acoustic meatus
evidence:
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "common presenting complaint was itchy ear (33.8%). Majority of patients (85.9%) had unilateral ear involvement"
explanation: Clinical study documenting the symptomatic presentation of otomycosis including pruritus and laterality.
phenotypes:
- name: Pruritus
description: >
Itching of the external auditory canal is frequently the predominant and
earliest symptom. It results from local epithelial irritation and
inflammation caused by fungal colonization.
frequency: VERY_FREQUENT
phenotype_term:
preferred_term: Pruritus
term:
id: HP:0000989
label: Pruritus
evidence:
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "common presenting complaint was itchy ear (33.8%)."
explanation: Pruritus was the most common presenting complaint in this clinical series.
- reference: PMID:38375517
reference_title: "Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "clotrimazole has the best or most significant effect on the treatment of otomycosis for patients suffering from pain, itching, swelling, and hearing loss."
explanation: Itching listed as a core symptom of otomycosis.
- name: Ear pain
description: >
Otalgia is a common symptom, typically less severe than in bacterial otitis
externa. It results from inflammation of the EAC skin.
frequency: FREQUENT
phenotype_term:
preferred_term: Ear pain
term:
id: HP:0030766
label: Ear pain
evidence:
- reference: PMID:38375517
reference_title: "Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "clotrimazole has the best or most significant effect on the treatment of otomycosis for patients suffering from pain, itching, swelling, and hearing loss."
explanation: Pain listed as a core symptom of otomycosis.
- name: Conductive hearing impairment
description: >
Hearing impairment results from obstruction of the ear canal by fungal
debris, hyphae, biofilm, and inflammatory material. It is typically
reversible with treatment.
frequency: FREQUENT
phenotype_term:
preferred_term: Conductive hearing impairment
term:
id: HP:0000405
label: Conductive hearing impairment
evidence:
- reference: PMID:38375517
reference_title: "Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "clotrimazole has the best or most significant effect on the treatment of otomycosis for patients suffering from pain, itching, swelling, and hearing loss."
explanation: Hearing loss listed as a core symptom of otomycosis.
environmental:
- name: Topical antibiotic use
description: >
Prolonged use of ototopical antibiotics (with or without steroids) is the
most common predisposing factor, disrupting the normal bacterial flora and
permitting fungal overgrowth.
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Aspergillus was the most common species isolated."
explanation: Systematic review identifies Aspergillus as the predominant pathogen, with ototopical antibiotics as the commonest predisposing factor (47% pooled estimate).
- name: Humid tropical climate
description: >
Hot, humid environments promote moisture retention in the ear canal, which
disrupts cerumen function and provides a favorable niche for fungal growth.
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Most of the studies were conducted in tropical and sub-tropical countries."
explanation: Systematic review confirming tropical/subtropical predominance.
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is common in environments with hot, humid weather"
explanation: Clinical study confirming association with hot, humid environments.
- name: Ear canal trauma from cleaning
description: >
Compulsive ear cleaning and instrumentation damage the epithelial lining
and remove protective cerumen, predisposing to fungal colonization.
evidence:
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "50.0% applied ototopic medications before presentation"
explanation: Clinical study documenting prior medication use as a predisposing factor.
treatments:
- name: Aural toilet and debridement
description: >
Thorough mechanical debridement of fungal debris from the external auditory
canal is the cornerstone of treatment and essential for topical antifungal
efficacy. The most common treatment modality used in clinical practice.
treatment_term:
preferred_term: surgical procedure
term:
id: MAXO:0000004
label: surgical procedure
evidence:
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "The most common treatment was local ear debridement and use of topical antifungal creams. Majority (91.5%) of the patients responded with resolution of fungal infection."
explanation: Clinical study confirming debridement plus topical antifungal as standard of care with 91.5% resolution.
- reference: PMID:40317309
reference_title: "Ear-canal lavage for curing noninvasive otomycosis: A randomized controlled trial."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "In the lavage group, 48 (48/52, 92.30%) patients were cured with initial treatment after three months of follow-up"
explanation: RCT demonstrating that ear canal lavage alone achieves 92.30% cure rate, comparable to lavage plus topical antifungal.
- name: Topical antifungal therapy
description: >
Topical clotrimazole is the most commonly used antifungal agent. Other
options include miconazole and nystatin. Systemic triazoles (fluconazole,
itraconazole) are reserved for severe or refractory disease.
treatment_term:
preferred_term: topical pharmacotherapy
term:
id: MAXO:0001573
label: topical pharmacotherapy
therapeutic_agent:
- preferred_term: clotrimazole
term:
id: CHEBI:3764
label: clotrimazole
- preferred_term: miconazole
term:
id: CHEBI:6923
label: miconazole
evidence:
- reference: PMID:38375517
reference_title: "Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Eight studies had similar results and claimed that clotrimazole has the best or most significant effect on the treatment of otomycosis"
explanation: Review supporting clotrimazole as the most effective topical treatment for otomycosis.
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "The most common treatment was local ear debridement and use of topical antifungal creams."
explanation: Confirms topical antifungal creams as standard clinical practice.
- reference: PMID:41019825
reference_title: "Comparison of Efficacy in the Treatment of Otomycosis using 10% Povidone-Iodine and Clotrimazole Solution: Randomized, Double-Blind Control Trial."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "In the 12th week after treatment, 76.34% of the 10% povidone-iodine group and 85.26% of the Clotrimazole group had a good response to treatment (p = 0.248)."
explanation: RCT showing clotrimazole achieves 85.26% response rate at 12 weeks, with povidone-iodine as a comparable alternative (76.34%, no significant difference).
- name: Acidifying agents
description: >
Acidifying agents such as 2% acetic acid or boric acid alcohol solutions
are used as alternatives to antifungals, particularly for mild cases or
antifungal-resistant species. They restore the acidic pH of the ear canal
that inhibits fungal growth.
treatment_term:
preferred_term: pharmacotherapy
term:
id: MAXO:0000058
label: pharmacotherapy
therapeutic_agent:
- preferred_term: acetic acid
term:
id: CHEBI:15366
label: acetic acid
- preferred_term: boric acid
term:
id: CHEBI:33118
label: boric acid
evidence:
- reference: PMID:38375517
reference_title: "Comparison of acidifying agents and clotrimazole for treatment of otomycosis: a comprehensive one-way mini-review."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "in the biomedical field, the re-emerging investigation attention is due to the statements of a number of mechanisms defending the use of acidifying agents to treat mycosis (of antifungal-resistant species)."
explanation: Supports acidifying agents as an alternative treatment approach, especially for resistant cases.
differential_diagnoses:
- name: Acute bacterial otitis externa
description: >
Bacterial otitis externa presents with similar symptoms of ear pain,
discharge, and canal edema. It is typically caused by Pseudomonas
aeruginosa or Staphylococcus aureus and produces purulent rather than
fungal debris. Bacterial infection tends to cause more severe pain
and canal edema than otomycosis.
disease_term:
preferred_term: acute otitis externa
term:
id: MONDO:0001051
label: acute otitis externa
distinguishing_features:
- Purulent discharge rather than fungal debris (hyphae, spores)
- More severe pain and canal edema
- Responds to topical antibiotics rather than antifungals
- Absence of characteristic fungal mat on otoscopy
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is a chronic or subacute fungal infection of external ear accounting to 5 to 20% of external ear infection worldwide."
explanation: Otomycosis represents a subset of otitis externa, requiring differentiation from the more common bacterial form.
- name: Seborrheic dermatitis
description: >
Seborrheic dermatitis of the external ear can mimic otomycosis with
pruritus, scaling, and flaking. It involves Malassezia yeast but
is a chronic inflammatory dermatosis rather than a true fungal
infection of the canal.
disease_term:
preferred_term: seborrheic dermatitis
term:
id: MONDO:0006608
label: seborrheic dermatitis
distinguishing_features:
- Scaling and flaking extends to conchal bowl and postauricular area
- Absence of fungal hyphae or conidiophores on microscopy
- Responds to topical steroids and antifungal shampoos
evidence:
- reference: PMID:33112026
reference_title: "Successful treatment of erythematous-squamous disorders of the external auditory canal with tacrolimus and clotrimazole in otic oil: Our experience in 25 patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Among the main dermatoses that can affect EAC seborrheic dermatitis, psoriasis, irritant or allergic contact dermatitis, chronic external otitis (atrial eczematoid dermatitis) and cutaneous lupus should be considered."
explanation: Clinical study identifying seborrheic dermatitis as the most common (56% of cases) erythematous-squamous dermatosis of the external auditory canal, presenting with symptoms overlapping otomycosis.
- name: Contact dermatitis of the ear canal
description: >
Allergic or irritant contact dermatitis from hearing aids, ear drops,
or earrings can present with pruritus, erythema, and discharge similar
to otomycosis. History of allergen exposure and patch testing help
differentiate.
disease_term:
preferred_term: contact dermatitis
term:
id: MONDO:0005480
label: contact dermatitis
distinguishing_features:
- History of allergen or irritant exposure (hearing aids, ear drops, jewelry)
- Absence of fungal elements on microscopy and culture
- Responds to allergen avoidance and topical corticosteroids
evidence:
- reference: PMID:33112026
reference_title: "Successful treatment of erythematous-squamous disorders of the external auditory canal with tacrolimus and clotrimazole in otic oil: Our experience in 25 patients."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Among the main dermatoses that can affect EAC seborrheic dermatitis, psoriasis, irritant or allergic contact dermatitis, chronic external otitis (atrial eczematoid dermatitis) and cutaneous lupus should be considered."
explanation: Clinical study listing allergic contact dermatitis among the main erythematous-squamous disorders of the EAC that must be differentiated from infectious causes.
- reference: PMID:1601193
reference_title: "Allergic contact dermatitis from the earmolds of hearing aids."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Hearing aid users with longstanding and severe dermatitis in the ear canal were examined by a dermatologist and patch tested."
explanation: Study documenting allergic contact dermatitis from hearing aid earmolds causing ear canal dermatitis, a key differential for otomycosis in hearing aid users.
- name: Cholesteatoma
description: >
Cholesteatoma can present with chronic otorrhea, hearing loss, and
debris in the ear canal. Unlike otomycosis, it involves keratinized
squamous epithelium in the middle ear and can cause bone erosion and
serious complications.
disease_term:
preferred_term: cholesteatoma
term:
id: MONDO:0006530
label: cholesteatoma
distinguishing_features:
- Pearly white keratin mass typically arising from the pars flaccida
- Associated with chronic otitis media and tympanic membrane perforation
- CT imaging shows soft tissue mass with possible bone erosion
- Requires surgical management rather than topical antifungals
evidence:
- reference: PMID:20717034
reference_title: "Ear canal cholesteatoma: meta-analysis of clinical characteristics with update on classification, staging and treatment."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Canal cholesteatoma is a rarity in otologic pathology, often leading to misdiagnosis as external otitis or otomycosis by physicians unfamiliar with the disease."
explanation: Meta-analysis explicitly noting that ear canal cholesteatoma is frequently misdiagnosed as otomycosis, establishing it as a key differential diagnosis.
definitions:
- name: Clinical diagnostic criteria for otomycosis
definition_type: DIAGNOSTIC_CRITERIA
description: >
Otomycosis is diagnosed clinically based on characteristic otoscopic
findings combined with symptomatology and confirmed by mycological
culture. No single internationally standardized diagnostic criteria
set exists; diagnosis relies on the triad of compatible symptoms,
characteristic otoscopic appearance, and positive fungal culture
or microscopy.
scope: adults and children
inclusion_criteria:
- preferred_term: External ear canal irritation symptoms
description: >
Symptoms of external ear canal irritation including pruritus,
otalgia, otorrhea, or aural fullness.
- preferred_term: Characteristic otoscopic findings
description: >
Characteristic otoscopic findings including fungal debris, hyphae,
spores, or conidiophores visible in the external auditory canal.
- preferred_term: Positive fungal identification
description: >
Positive fungal culture or direct microscopy showing fungal
elements (KOH preparation or Gram stain).
exclusion_criteria:
- preferred_term: Middle ear pathology as primary source
description: >
Otitis media or middle ear pathology as the primary source
of symptoms.
- preferred_term: Necrotizing otitis externa
description: >
Malignant otitis externa (necrotizing otitis externa) with
bone involvement.
evidence:
- reference: PMID:38962337
reference_title: "Clinicopathological study of otomycosis in a tertiary hospital in South-west Nigeria."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "common presenting complaint was itchy ear (33.8%). Majority of patients (85.9%) had unilateral ear involvement"
explanation: Clinical study documenting the typical diagnostic presentation of otomycosis.
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is a chronic or subacute fungal infection of external ear accounting to 5 to 20% of external ear infection worldwide."
explanation: Systematic review establishing the clinical definition of otomycosis.
- reference: PMID:40317309
reference_title: "Ear-canal lavage for curing noninvasive otomycosis: A randomized controlled trial."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "This study demonstrated that the diagnosis of otomycosis requires vigilance from clinicians given its nonspecific or minor symptoms."
explanation: RCT noting the diagnostic challenge of otomycosis due to nonspecific symptoms, supporting the need for systematic diagnostic criteria.
- reference: PMID:41452477
reference_title: "Otomycosis in Southern China: a retrospective analysis of clinical presentation, otoendoscopic features, and causative pathogens."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "These features (especially crusts, congestion, swelling, and fungoid substance) were significantly associated with fungal positivity."
explanation: Large retrospective study identifying otoendoscopic features significantly associated with fungal positivity, supporting otoscopic findings as a diagnostic criterion.
- reference: PMID:36060244
reference_title: "Efficient and accurate diagnosis of otomycosis using an ensemble deep-learning model."
supports: SUPPORT
evidence_source: COMPUTATIONAL
snippet: "the average accuracy of the overall validation sample reached 92.42%."
explanation: Deep learning model achieving 92.42% diagnostic accuracy for otomycosis using otoendoscopic images, distinguishing otomycosis from impacted cerumen, external otitis, and normal ear canals.
clinical_trials:
- name: NCT05660382
phase: PHASE_III
status: RECRUITING
description: >
Randomized, double-blind, Phase III study evaluating the efficacy and safety
of miconazole oil versus placebo in the treatment of otomycosis over 14 days.
target_phenotypes:
- preferred_term: Pruritus
term:
id: HP:0000989
label: Pruritus
- preferred_term: Ear pain
term:
id: HP:0030766
label: Ear pain
evidence:
- reference: clinicaltrials:NCT05660382
supports: SUPPORT
snippet: "The goal of this clinical trial is to prove the that miconazole oil works well on fungal infections of the ears, by comparing the drug with a placebo."
explanation: Phase III trial directly targeting otomycosis treatment with miconazole oil.
- name: NCT04432376
phase: PHASE_III
status: COMPLETED
description: >
Randomized, double-blind, Phase III study evaluating the efficacy and safety
of miconazole oil 2% versus vehicle oil in otomycosis treatment, followed by
an open-label safety evaluation with 14 days of twice daily application.
target_phenotypes:
- preferred_term: Pruritus
term:
id: HP:0000989
label: Pruritus
- preferred_term: Conductive hearing impairment
term:
id: HP:0000405
label: Conductive hearing impairment
evidence:
- reference: clinicaltrials:NCT04432376
supports: SUPPORT
snippet: "The intention of the study is to evaluate the efficacy of Miconazole Oil on fungal infection of the ears when applied using 5 drops into the ear(s) twice daily for 14 days continuously."
explanation: Completed Phase III trial evaluating miconazole oil for otomycosis treatment.
- name: NCT01547221
phase: NOT_APPLICABLE
status: COMPLETED
description: >
Randomized controlled trial comparing the clinical effectiveness and adverse
events of 1% clotrimazole solution versus 3% boric acid in 70% alcohol for
the treatment of otomycosis.
target_phenotypes:
- preferred_term: Pruritus
term:
id: HP:0000989
label: Pruritus
- preferred_term: Ear pain
term:
id: HP:0030766
label: Ear pain
evidence:
- reference: clinicaltrials:NCT01547221
supports: SUPPORT
snippet: "Objective is to compare the clinical effectiveness and adverse events of 1% clotrimazole solution versus 3% boric acid in 70% alcohol for the treatment of otomycosis."
explanation: Completed RCT comparing two standard topical treatments for otomycosis.
notes: >
Aspergillus species (particularly A. niger and A. flavus) and Candida species
(particularly C. parapsilosis and C. tropicalis) are the most common causative
agents. The species distribution varies by geographic region. Molecular
taxonomy using calmodulin gene sequencing has revealed that many isolates
previously identified as A. niger are actually A. welwitschiae or A.
tubingensis (PMID:37257666), which has implications for antifungal susceptibility
profiling. Emerging Candida species including C. auris (with ERG11p Y132F
azole resistance mutation) have been isolated from otomycosis cases in
South Asia (PMID:37367594). Cerumen contains a broad repertoire of
antimicrobial proteins including defensins (hBD1-3), cathelicidin LL-37,
lysozyme, lactoferrin, BPI, and immunoglobulins (IgA, IgG). The ABCC11 gene
polymorphism determines earwax phenotype (wet vs dry) and is associated with
differences in ear canal microbiota composition, potentially modifying
susceptibility. Antifungal resistance mechanisms include cyp51A alterations
in Aspergillus species and biofilm-mediated phenotypic resistance. In a large
Chinese series (PMID:38578519), topical azole resistance was approximately
30% among Aspergillus isolates, and cyp51A mutations combined with mdr1/mfs
efflux pump overexpression contribute to multifactorial azole resistance in
Aspergillus section Nigri (PMID:38486086). Povidone-iodine (10%) has been
shown to be a viable alternative to clotrimazole in resource-limited settings
(PMID:41019825), and nanocrystalline silver demonstrated 89% cure rates in a
100-patient series (PMID:37223402). Deep learning models using otoendoscopic
images can achieve 92.42% diagnostic accuracy (PMID:36060244). Novel
therapeutic approaches under investigation include pterostilbene-loaded PLGA
nanoparticles that can penetrate fungal biofilm matrix. Refractory cases may
require topical voriconazole even after prolonged systemic therapy fails
(PMID:36632528).
classifications:
harrisons_chapter:
- classification_value: infectious disease
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is a chronic or subacute fungal infection of external ear accounting to 5 to 20% of external ear infection worldwide."
explanation: Otomycosis is classified as a fungal infectious disease.
- classification_value: fungal infectious disease
evidence:
- reference: PMID:39376298
reference_title: "Topical Antibiotic-Induced Otomycosis - a Systematic Review of Aetiology and Risk Factors."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Otomycosis is a chronic or subacute fungal infection of external ear accounting to 5 to 20% of external ear infection worldwide."
explanation: Specifically a fungal infection of the external ear.
datasets:
references:
- reference: DOI:10.1016/j.mycmed.2021.101115
title: 'Otomycosis in Africa: Epidemiology, diagnosis and treatment'
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: 'Otomycosis in Africa: Epidemiology, diagnosis and treatment'
supporting_text: 'Otomycosis in Africa: Epidemiology, diagnosis and treatment'
- reference: DOI:10.1111/myc.13532
title: 'Otomycosis: The foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in North‐Western Iran'
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Otomycosis is considered a recurring fungal ear infection.
supporting_text: Otomycosis is considered a recurring fungal ear infection.
evidence:
- reference: DOI:10.1111/myc.13532
reference_title: 'Otomycosis: The foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in North‐Western Iran'
supports: SUPPORT
evidence_source: OTHER
snippet: Otomycosis is considered a recurring fungal ear infection.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.1177/19160216251330629
title: Pooled Analysis of 2 Randomized Clinical Trials to Evaluate the Efficacy and Safety of Clotrimazole 1% Otic Solution for the Treatment of Otomycosis in Adults
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Importance There is no antifungal otic drug for the treatment of otomycosis approved in the United States.
supporting_text: Importance There is no antifungal otic drug for the treatment of otomycosis approved in the United States.
evidence:
- reference: DOI:10.1177/19160216251330629
reference_title: Pooled Analysis of 2 Randomized Clinical Trials to Evaluate the Efficacy and Safety of Clotrimazole 1% Otic Solution for the Treatment of Otomycosis in Adults
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: Importance There is no antifungal otic drug for the treatment of otomycosis approved in the United States.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.1186/s12879-025-10954-y
title: 'Otomycosis: a systematic review and meta-analysis of prevalence and causative agents in the era of molecular diagnostics'
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: 'Otomycosis: a systematic review and meta-analysis of prevalence and causative agents in the era of molecular diagnostics'
supporting_text: 'Otomycosis: a systematic review and meta-analysis of prevalence and causative agents in the era of molecular diagnostics'
- reference: DOI:10.26502/fjhs.162
title: 'Mycologic Epidemiology and Antifungal Susceptibility Patterns of Otomycosis in Yaounde, Cameroon: A Cross Sectional Study Revealing Candida albicans Dorminance and Nystatin Sensitivity'
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: 'Mycologic Epidemiology and Antifungal Susceptibility Patterns of Otomycosis in Yaounde, Cameroon: A Cross Sectional Study Revealing Candida albicans Dorminance and Nystatin Sensitivity'
supporting_text: 'Mycologic Epidemiology and Antifungal Susceptibility Patterns of Otomycosis in Yaounde, Cameroon: A Cross Sectional Study Revealing Candida albicans Dorminance and Nystatin Sensitivity'
- reference: DOI:10.3126/ajms.v14i8.54270
title: A study of clinico-mycological profile and treatment of primary otomycosis
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Otomycosis is a superficial mycotic infection of the external auditory canal.
supporting_text: Otomycosis is a superficial mycotic infection of the external auditory canal.
evidence:
- reference: DOI:10.3126/ajms.v14i8.54270
reference_title: A study of clinico-mycological profile and treatment of primary otomycosis
supports: SUPPORT
evidence_source: OTHER
snippet: Otomycosis is a superficial mycotic infection of the external auditory canal.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.3390/jof8030315
title: Clinical Presentations, Cluster Analysis and Laboratory-Based Investigation of Aspergillus Otomycosis—A Single Center Experience
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Species of Aspergillus (A.) niger complex and A. flavus complex are predominant molds that are causative agents of otomycoses.
supporting_text: Species of Aspergillus (A.) niger complex and A. flavus complex are predominant molds that are causative agents of otomycoses.
evidence:
- reference: DOI:10.3390/jof8030315
reference_title: Clinical Presentations, Cluster Analysis and Laboratory-Based Investigation of Aspergillus Otomycosis—A Single Center Experience
supports: SUPPORT
evidence_source: OTHER
snippet: Species of Aspergillus (A.) niger complex and A. flavus complex are predominant molds that are causative agents of otomycoses.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.3390/jof9060662
title: 'Etiology, Predisposing Factors, Clinical Features and Diagnostic Procedure of Otomycosis: A Literature Review'
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC) with a worldwide prevalence ranging from 9% to 30%.
supporting_text: Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC) with a worldwide prevalence ranging from 9% to 30%.
evidence:
- reference: DOI:10.3390/jof9060662
reference_title: 'Etiology, Predisposing Factors, Clinical Features and Diagnostic Procedure of Otomycosis: A Literature Review'
supports: SUPPORT
evidence_source: OTHER
snippet: Otomycosis (OM) is a superficial fungal infection of the external auditory canal (EAC) with a worldwide prevalence ranging from 9% to 30%.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.36347/sajb.2024.v12i08.001
title: Otomycosis, Review
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal.
supporting_text: The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal.
evidence:
- reference: DOI:10.36347/sajb.2024.v12i08.001
reference_title: Otomycosis, Review
supports: SUPPORT
evidence_source: OTHER
snippet: The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal.
explanation: Deep research cited this publication as relevant literature for Otomycosis.
- reference: DOI:10.51984/jopas.v23i2.3122
title: Prevalence and Etiology of Otomycosis in West Libya
found_in:
- Otomycosis-deep-research-falcon.md
findings:
- statement: Fungal otitis media is a frequently case facing otolaryngologists due to its recurrence and long-Fungal otitis media is a frequent condition faced by otolaryngologists due to its recurrence and long-term treatment period.
supporting_text: Fungal otitis media is a frequently case facing otolaryngologists due to its recurrence and long-Fungal otitis media is a frequent condition faced by otolaryngologists due to its recurrence and long-term treatment period.
evidence:
- reference: DOI:10.51984/jopas.v23i2.3122
reference_title: Prevalence and Etiology of Otomycosis in West Libya
supports: SUPPORT
evidence_source: OTHER
snippet: Fungal otitis media is a frequently case facing otolaryngologists due to its recurrence and long-Fungal otitis media is a frequent condition faced by otolaryngologists due to its recurrence and long-term treatment period.
explanation: Deep research cited this publication as relevant literature for Otomycosis.