Article

Effectiveness of oral itraconazole in the management of otomycosis with tympanic membrane perforation

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: Otomycosis can be a difficult problem to treat in a patient who already has a perforation of the tympanic membrane. This study highlights the effectiveness of oral Itraconazole in treating such cases.Methods: Thirty-four patients with otomycosis and a perforated tympanic membrane were included in the study and were treated with oral itraconazole and antibiotic ear drops. They were followed up for six weeks to look for treatment response and any recurrence.Results: Of the 34 patients in the study, 25 patients were fully cured with one week of oral Itraconazole therapy. Six out of the remaining 9 patients were cured of the disease with two weeks’ therapy. Three patients needed prolonged treatment and one patient had a recurrence at six weeks.Conclusions: Oral itraconazole therapy is an effective alternative to the traditional methods of treatment for otomycosis with tympanic membrane perforation.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... In line with our findings, in a singleblind randomized clinical study, 93.3% of the cases treated with clotrimazole and lignocaine solutions demonstrated an improvement in the clinical symptoms of itching and discharge, and ear pain was recovered in 86.7% of the patients [20]. In another study, Aju and Sagesh (2017) used a combination therapy with oral itraconazole and ofloxacin ear drops for the treatment of otomycosis [21] and reported similar results. ...
... Our results are inconsistent with those of other studies [2,5,21,25]. These differences can be due to the type of pathogenic etiological agents, anatomy of the ear, immune system status, and tympanic membrane perforation. ...
Article
Full-text available
Background and Purpose There are controversial findings regarding the efficacy of antifungal drugs in the treatment of a ruptured eardrum following fungal infections. Regarding this, the aim of the present study was to evaluate the therapeutic effect of the co-administration of antifungal and antibacterial agents in the treatment of otomycosis with tympanic membrane perforation. Materials and Methods This analytical, clinical trial was conducted on 87 patients with otomycosis showing no bacterial elements in the direct observation and culture. The study population was assigned into two groups of intervention (n=45) and control (n=42). The demographic and clinical data, as well as the data related to the direct observation and culture of the ear samples were recorded in a checklist. All statistical analysis was performed in SPSS (version 24). Results The most prevalent symptoms in both groups were hearing loss and itching, and the most common finding was secretion. Aspergillus and Candida were the most frequent fungi isolated from the samples. After the implementation of combination therapy, the intervention group demonstrated a significant decrease in symptoms and signs, compared to the control group (P=0.005). Conclusion The findings of the present study indicated that the use combination therapy with ceftizoxime powder and clotrimazole ointment was effective the in treatment of the patients with tympanic membrane rupture showing no bacterial effects in direct examination and culture.
... Controversy exists between the types of antifungal ointment to be prescribed by otorhinolaryngologists. 11 We have compared nystatin versus isoconazole in present study. There is no previous study which has particularly compared these two antifungals. ...
Article
Full-text available
Objective: To compare isoconazole nitrate versus nystatin for treatment of otomycosis. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Bahawalpur and Combined Military Hospital Mardan, from Jan to Dec 2018. Methodology: Total 204 cases fulfilling the inclusion criteria were selected from outpatient department of Combined Military Hospital Bahawalpur and Mardan. They were divided into 2 groups of 102 each using random number tables. Group A cases were given Isocona-zole nitrate for application in external auditory meatus and group B cases were given Nystatin. All the cases were examined two weeks later and outcome was compared in terms of clinical improvement and symptoms resolution. Results: Out of 204, 125 patients were females and rest 79 were males. Age range was from 12-87 years with mean age 31 ± 2.4. Both groups were identical in terms of gender. In group A patients, 74 (72.5%) showed marked improvement after two week, 15 (14.7%) showed moderate improvement and 13 (12.7%) showed minor improvement. However, in group B, 55 (53.9%) showed marked improvement after two week, 23 (22.5%) showed moderate improvement and 24 (23.5%) showed minor improvement. Group A treatment was found significantly better than group B treatment (p=0.021). Conclusion: Isoconazole nitrate ointment was found significantly more effective for treating otomycosis than nystatin.
... Otomycosis is well known for its recurrence if proper treatment is not initiated [17]. Treatment such clotrimazole coupled with mechanical debridement are generally effective and the infection display a lower recurrence rate [18] The case highlights situation of ear self-injury related to schizophrenia disorders and co-occurring otomycosis. ...
Article
Full-text available
Ear self-mutilation have been reported in schizophrenia, Mechanical damages to the auditory canal, like cleaning ear with hard and unsterile objects are predisposing factors of otomycosis.We present a case of repeated self-induced auricular trauma in schizophrenic patient. Aural swab were collected and examined by direct microscopy and culture, revealing Aspergillus flavus. A traumatized external ear canal skin can present favourable condition for fungal growth in the psychiatric population. Keywords: Aspergillus flavus, Ear-injury, Otomycosis, Schizophrenia, Self-injury
Article
Full-text available
Otomycosis (or fungal Otitis externa) is a troublesome infection of External ear usually by Aspergillus or Candida. Chronic and recurrent Otomycosis is frequently seen in Diabetic and elderly patients. This study highlights that Oral Itraconazole at a daily dose of 200mg/day for 5 days is an effective and safe remedy for treatment of Otomycosis in Diabetic patients. In addition early and quasi-urgent eradication of fungus provides for prevention of Fungal Malignant Otitis externa, (Invasive Otitis externa) or Skull base osteomyelitis.
Article
Full-text available
Objectives : The aim of this study was to determine the frequency of otomycosis, the clinical presentation, predisposing factors and treatment outcomes. Methods: This observational study was conducted at ENT department of Combined Military Hospital Attock, from October, 2010 to September, 2012. Convenient sample comprising 180 patients of both sexes and all age groups were selected from ENT OPD. The frequency, predisposing factors and most common symptoms of otomycosis were recorded. The response to different antifungal agents was also observed. Results were recorded in percentages. Results: There were 180 patients with documented diagnosis of otomycosis. There were 107 (59%) males and 73 (41%) females. The age of patients ranged from 1½ years to 75 years with a mean age of 38.5 years. Mean follow up time was 2 years. Most common presenting symptom was hearing loss (77.7%) followed by pruritis (68.8%) and otalgia (40%). We prescribed 1% clotrimazole drops or lotion in 58% patients and 2% salicylic acid in 31% cases. Both of these agents are effective. Topical 1% clotrimazole drops yielded highest resolution rate with lowest recurrent rate. Overall 149 (83%) patients were improved with initial treatment and 31 (17%) did not respond to initial treatment. Eight (4.4%) patients had a history of otological procedures. Four (2.2%) patients had canal wall down procedures that resulted in mastoid cavity. To analyse the efficacy of 1% clotrimazole and 2% salicylic acid we applied Z-Test to calculate the difference between 2 proportions of patients before treatment with those patients who remained uncured after treatment. Conclusion: Otomycosisis commonly presented with decreased hearing, pruritis, otalgia & otorrhoea. It usually resolves with local toilet of ear and instillation of antifungal agents. Eradication of disease is difficult in presence of a mastoid cavity and metabolic diseases like diabetes mellitus.
Article
Background As the use of the newer oral antifungal agents for the treatment of superficial fungal infections becomes more widespread, the issue of safety surrounding their use is becoming an increasingly important consideration. Itraconazole is effective and well tolerated, with most side effects being minor and reversible. The most common adverse events are gastrointestinal upset, headache, and transient skin reaction. There have also been rare reports of hepatitis. Objective To assess the hepatic safety of pulse and continuous itraconazole in the treatment of onychomycosis. Methods An analysis was performed on all itraconazole clinical trials sponsored by Janssen Research Foundation in the treatment of onychomycosis, where there was an assessment of laboratory safety. A review of the published literature was also undertaken to assess the hepatic safety of itraconazole in common practice. Results The data indicate that itraconazole pulse treatment is safe, with no significant differences in the number of code 4 abnormalities (baseline value is in the normal range and at least two values, or the last testing in the observation period, exceed twice the upper limit of normal) in the liver function parameters studied: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and total bilirubin. The incidence of all the code 4 abnormalities was below 2%. In the literature there are reports of symptomatic hepatitis with itraconazole continuous therapy but no published report of symptomatic hepatotoxicity using the pulse regimen. Conclusions Itraconazole pulse therapy for onychomycosis appears to be safe, especially from the perspective of potential liver damage. In the itraconazole package insert liver function tests are recommended for patients receiving continuous itraconazole for periods of time exceeding 1 month. There is no such monitoring requirement for the pulse regimen unless the patient has a history of underlying hepatic disease, the liver function tests are abnormal at baseline, or at any time that there is the development of signs or symptoms suggestive of liver dysfunction.
Article
Introduction: Otomycosis is a fungal infection of the external ear canal that can involve the middle ear in case of tympanic membrane perforation and also extend to the auricle. Fungi cause 7-15% of external otitis. Diagnosing otomycosis is often based entirely on non-specific clinical signs and symptoms. A multitude of antifungal drugs are available. Some are ototoxic in animals, a few are proven safe, but the ototoxicity of many drugs remains unknown. The aim of this study was to describe how otomycosis was diagnosed and treated by private ear, nose, and throat (ENT) consultants in Denmark and to investigate if the patient's immune status and the presence of a tympanic membrane perforation affected the chosen treatment modality. Method: A questionnaire on the treatment of otomycosis was sent to 147 private ENT consultants. Results: In total, 103 (70%) responded. 95% performed intensive aural cleaning using an otomicroscope. The initial diagnosis was based on symptoms as only 20% required to see fungal hypha. 42% sent material for culture and sensitivity (C + S) before starting treatment and 92% sent for C + S if treatment failed. 89% used a variety of topical antifungal drugs as the first line of medical treatment. Antiseptics were used in 5%. The presence of a tympanic membrane perforation did not alter the treatment modality. Only 13% treated immunocompromised patients differently. Conclusion: The initial diagnosis was based on non-specific symptoms and there were large discrepancies in the chosen antifungal treatment. Topical antifungal drugs were preferred. Additional research is needed. Funding: Department of Otorhinolaryngolgy and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark. The Danish Association of Research-interested Otorhinolaryngology Consultants: Kim Werther, Peter Tingsgaard, Mads Stougaard, Steen Telmer, Henrik Møller, Liviu Guldfred. Trial registration: No trial registration was necessary as the questionnaire was anonymous and contained no patient data.
Article
Twenty one patients with otomycosis were treated with oral Itraconazole tablets. The patients were given 50 mg or 100 mg of Itraconazole per day until clinical symptoms improved. The overall effectiveness rates were 42.9% (9/21) with excellent efficacy, 38.1% (8/21) with good efficacy, 4.8% (1/21) with no efficacy respectively. The fungus culture tests were negative in 8 patients among the 15 who underwent fungus culture tests after treatment. A sufficient amount of Itraconazole to be therapeutic was detected in the cerumen of one patient (118.81 ng/gr. after 2 weeks administration, and 453.56 ng/gr. after 4 weeks administration, respectively), and concentrations exceeded most of MIC (0.063-1 μg/ml). An adverse reaction was experienced by only one patient, a 59 y.o. male, who suffered from diarrhea. Abnormal laboratory data were found in a 73 y.o. male, among the 11 patients who underwent blood tests both before and after the treatment, showing minor elevation of GOT and GPT. These observations suggest that Itraconazole is a safe and useful oral medicine for treatment of otomycosis.
Article
Mycological analysis was carried out on debris, scraping or exudate samples from the externalauditory canal(s) of 102 patients clinically suspected cases of otomycosis. The total number ofsamples taken from 102 patients were 108, of which 102 samples were obtained from one ear and 6samples from the other ear. Predisposing factors contributing to such a presentation weredermatomycosis (51.22%), turban usage (29.26%), veil usage (14.63%) and swimming (4.88%).Only 82 (75.92%) samples were positive for the presence of fungal elements, of which 48(44.44%)specimens were smear and culture positive while 34(31.48%) were smear negative but culturepositive. Males and females were almost equally affected, ratio being (1.1:1). Chief fungal isolatesincluded Aspergillus niger (52.43%), Aspergillus fumigatus (34.14%), Candida albicans (11%),Candida pseudotropicalis (1.21%) and Mucor sp. (1.21%). Among 8 patients mixed fungal growthwas obtained, while bacterial coinfection/ superinfection was detected in 14 cases.
Article
Aspergillus and Candida spp are the most frequently isolated fungi in patients with otomycosis. The diagnosis of otitis externa relies on the patient's history, otoscopic examination under microscopic control, and imaging studies. Direct preparation of the specimens, particularly with optical brighteners, mycologic culture, and histologic examination, is very important and strongly recommended for the correct diagnosis. Patients with noninvasive fungal otitis externa should be treated with intense débridement and cleansing, and topical antifungals. Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate, are potentially safe choices for the treatment of otomycosis, especially in patients with a perforated eardrum. The oral triazole drugs, itraconazole, voriconazole, and posaconazole are effective against Candida and Aspergillus, with good penetration of bone and the central nervous system. These drugs are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis.
Article
To investigate a relationship between the etiological factor of external otitis and occurrence of particular signs/symptoms. A special questionnaire was designed and completed by all patients covering personal details, medical history, results of otolaryngological examination and bacteriological and mycological investigations. 249 patients of the Outpatient Department of Laryngology at the Regional Hospital in Bełchatów with symptoms of external otitis. For analysis of relationships between particular signs/symptoms and species/genera of microorganisms, statistical tests were used: chi2 test, chi2 test with Yate's modification, C-Pearson index, and Fisher exact test for very small samples. There is a statistical dependence between discharge, hearing loss, swelling of skin, scant, dried discharge with fetid odour and bacteria isolated from the external ear canal. Similar dependence exists between pain, hearing loss, no smelly discharge or wet, black plug of fetid odour and fungi. Also there is a statistical dependence between pruritus, red skin and grey, fetid discharge and mixed flora. Some of symptoms and signs are connected with definite etiological factors which is important not only for correct diagnosis but also for institution of appropriate and effective treatment. On the basis of some characteristic symptoms and signs it is possible to make a tentative diagnosis as to the etiological pathogen responsible for external otitis.
Article
Twenty-two cases of perforated tympanic membrane due to fungal otitis externa were observed over a five-year period. The diagnosis of fungal otitis externa was made on clinical grounds due to the obvious presence of fungal bloom in the external ear canal. Some perforations were noted at the first treatment after the fungal debris had been removed from the external ear canal using a microscope. Other perforations were observed to develop over a few days. Initially, a discrete area of the tympanic membrane appeared white and opaque. As time progressed the white area disintegrated, forming a perforation. Once the otitis externa had resolved most perforations healed spontaneously. Two that were observed to develop during treatment required a myringoplasty. Another one closed significantly but a tiny persistent perforation required cauterization with trichloracetic acid to encourage it to close over completely. The only residual hearing loss was in a case with almost total disintegration of the tympanic membrane requiring a myringoplasty. Treatment of fungal otitis externa for the patients in this series was aural toilet using suction under a microscope and insertion of a gauze wick saturated in a combination of hydrocortisone, clotrimazole, framycetin and gramicidin.
Unlabelled: Prior to 1999, the diagnosis of otomycosis as a cause of persistent otorrhea was rare. An increase incidence has been seen in among our outpatient pediatric otolaryngology practice. The purpose of this study is to assess the contribution of ototopical antibiotic drops to the development of otomycosis. Design: Retrospective study. Setting: Pediatric otolaryngology outpatient center. Methods: Chart review of all patients diagnosed with otomycosis between June 1999 and September 2001. Twenty-six patients (ages 17 months-29 years) were diagnosed with otomycosis based on clinical and microbiological findings after treatment with topical ofloxacin antibiotic drops. All patients had used ototopical antibiotics, including ofloxacin in every case, for presumed bacterial otorrhea. Once the fungal source was recognized, therapy succeeded in each case (26/26). Physicians need an elevated suspicion of otomycosis as a cause of persistent otorrhea, especially following treatment with topical antibiotic drops. Appropriate treatment of otomycosis eliminates otorrhea. Ofloxacin remains an excellent choice for bacterial otorrhea, but it appears to increase the incidence of otomycosis. Thus, its usage warrants careful post-treatment follow-up.
There has been an increase in the prevalence of otomycosis in recent years. This has been linked to the extensive use of antibiotic eardrops. Treatment of otomycosis is challenging, and requires a close follow-up. We present a review of the literature on otomycosis, the topical antifungals most commonly used, and discuss their ototoxic potential. Candida albicans and Aspergillus are the most commonly identified organisms. Antifungals from the Azole class seem to be the most effective, followed by Nystatin and Tolnaftate.
Issue 4 Page 1376 clinics in Denmark
International Journal of Research in Medical Sciences | April 2017 | Vol 5 | Issue 4 Page 1376 clinics in Denmark. Danish Med J. 2016;63(5):A5231.
Hepatic safety of Itraconazole Effect of Oral Itraconazole Tablets on Otomycosis
  • Ak Gupta
  • E Chwetzoff
  • Del Rosso
  • J Baran
  • R Amesara
  • R Suzumara
  • E Ryuichiro
  • Setsuonakamoto
Gupta AK, Chwetzoff E, Del Rosso J, Baran R. Hepatic safety of Itraconazole. J Cutan Med Surg. 2002;6(3):210-3. 11. Amesara R, Suzumara E, Ryuichiro, SetsuoNakamoto. Effect of Oral Itraconazole Tablets on Otomycosis. Practica Oto-RhinoLaryngologica. 1999;92(2):201-6.
  • A Ravindran
Ravindran A et al. Int J Res Med Sci. 2017 Apr;5(4):1373-1376