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Otomycosis (Fungal Otitis Externa): Disease Characteristics Research Report

2026-04-04
Falcon MONDO:0000262 Model: Edison Scientific Literature 49 citations

Otomycosis (Fungal Otitis Externa): Disease Characteristics Research Report

Target disease: Otomycosis (infectious; fungal infection of the external ear canal).

Executive summary (current understanding)

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)

1. Disease information

1.1 What is the disease?

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)

1.2 Key identifiers (ontology/terminology)

  • MONDO ID: Not identified from the retrieved evidence corpus.
  • ICD-10/ICD-11, MeSH: Not extractable from the retrieved evidence corpus.

1.3 Evidence source type

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)

2. Etiology

2.1 Disease causal factors

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)

2.2 Risk factors (prioritize 2023–2024)

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)

2.3 Protective factors

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)

2.4 Gene–environment interactions

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)

3. Phenotypes

3.1 Clinical phenotype spectrum

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)

3.2 Age of onset, severity, and course

Otomycosis can be acute, subacute, or chronic, typically unilateral, with bilateral disease more frequent in immunocompromised patients. (bojanovic2023etiologypredisposingfactors pages 1-2)

3.3 Quality of life impact

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)

3.4 Suggested HPO terms (examples)

  • Pruritus: HP:0000989
  • Otalgia: HP:0000366
  • Otorrhea: HP:0001754
  • Hearing impairment: HP:0000365
  • Tinnitus: HP:0000360
  • Ear fullness (aural fullness; no single canonical HPO term universally used; can map to related concepts such as abnormal sensation in ear)
  • Scaling/desquamation: HP:0001056 (abnormality of skin exfoliation), context EAC

(These are ontology suggestions; not directly asserted by the cited articles.)

4. Genetic / molecular information

4.1 Causal genes / pathogenic variants

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)

4.2 Molecular information relevant to otomycosis

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)

5. Environmental information

5.1 Environmental and lifestyle contributors

5.2 Infectious agents (pathogens)

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)

6. Mechanism / pathophysiology

6.1 Causal chain (trigger → clinical manifestation)

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)

6.2 Biofilms and relapse (recent evidence)

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)

6.3 Suggested ontology terms

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.

7. Anatomical structures affected

7.1 Organ/tissue localization

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)

8. Temporal development

8.1 Onset and progression

Otomycosis can be acute, subacute, or chronic. (bojanovic2023etiologypredisposingfactors pages 1-2)

8.2 Recurrence/relapse

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)

9. Inheritance and population

9.1 Epidemiology (statistics from recent studies)

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)

9.2 Demographics and geographic distribution

10. Diagnostics

10.1 Clinical examination

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)

10.2 Laboratory diagnostics

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)

10.3 Differential diagnosis

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)

11. Outcome / prognosis

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)

12. Treatment

12.1 Key concepts (current standard of care)

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)

12.2 Evidence for clotrimazole (recent higher-quality RCT evidence)

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)

12.3 Susceptibility/resistance signals

  • In a 2023 primary study, the authors note an “increasing trend of antifungal resistance” (including for commonly used agents such as fluconazole and clotrimazole) and emphasize variability by region. (alam2023astudyof pages 1-2)
  • A 2023 molecular study performed susceptibility testing and raised concerns about MIC distributions for triazoles relative to ECVs over time. (roohi2023otomycosistheforemost pages 1-2)

12.4 Real-world implementations (durations, monitoring, ototoxicity considerations)

  • In an Africa-focused review, recommended management includes “suction clearance of fungal mass,” discontinuation of topical antibiotics, and “treatment with antifungal eardrops for three weeks,” with instruction that the “Ear should be kept dry and hygiene for three weeks” and follow-up mycological testing. (sangare2021otomycosisinafrica pages 4-5)
  • Ototoxicity considerations: imidazoles are discussed as usable even with perforation (with technique cautions), clotrimazole is described as “considered free of ototoxic effects,” and the review emphasizes considering ototoxicity when the tympanic membrane is perforated. (sangare2021otomycosisinafrica pages 5-6, sangare2021otomycosisinafrica pages 4-5)

12.5 Experimental / clinical trial landscape (registry evidence)

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)

12.6 Suggested MAXO and CHEBI mappings (examples)

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

13. Prevention

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)

14. Other species / natural disease

No veterinary/natural disease cross-species evidence was identified in the retrieved corpus.

15. Model organisms

No model organism systems specific to otomycosis pathogenesis were identified in the retrieved corpus.

Recent developments (2023–2024 emphasis)

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)

Expert opinions / consensus themes (authoritative sources)

Visual evidence (table)

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)

Structured evidence synthesis table

Table (click to expand)
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.

Source notes and limitations

  • Ontology identifiers (MONDO/ICD/MeSH): not extractable from the available retrieved evidence; should be added via direct ontology database lookup.
  • Many epidemiology estimates are clinic-ascertained and not directly generalizable to population incidence/prevalence.
  • Comparative effectiveness across topical agents remains limited by heterogeneity and sparse high-quality head-to-head trials, as emphasized by treatment reviews. (yassin2023comparisonofacidifying pages 2-3)

References

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  31. (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.

  32. (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.

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