Ear-canal lavage for curing noninvasive otomycosis: A randomized controlled trial.

Objective: Fungal infection of the external auditory canal, otomycosis, is generally a superficial, but sometimes stubborn mycotic infection that rarely involves the middle ear. We designed a randomized, controlled cohort study to analyse the treatment effect of ear canal lavage on otomycosis.

Methods: The clinical patients were divided into two groups: an irrigation group and an irrigation + local drug treatment control group. The patients were followed up once a month for three months.

Results: From January 2022 to December 2023, a total of 102 patients treated for otomycosis were enrolled, and 98 of the patients were followed up for three months. 22 of the 98 patients (22.45%) had no or minor symptoms. Common symptoms such as pruritus, pain, hearing impairment, etc., presented solely or in combination. Our fungal culture results revealed that, in 83 patients (84.69%), the otomycotic pathogen was Aspergillus, in 3 patients (3.06%) it was Penicillium, in 2 patients (2.04%) it was Candida species, and in the remaining 13 patients (13.27%) it was negative. There were 3 patients (3.06%) with a mixture of fungal culture reports. In the lavage group, 48 (48/52, 92.30%) patients were cured with initial treatment after three months of follow-up, two (2/52, 3.85%) patients were cured after one month but were lost to follow-up after three months, and two (2/52, 3.85%) patients failed after initial treatment, received topical miconazole ointment treatment and were eventually cured. In the irrigation + local drug control group, 48 (48/50, 96.00%) subjects responded to initial treatment without recurrent disease after three months; 2 (2/50, 4.00%) subjects were lost to follow-up. According to Fisher's exact test, there was no significant difference in treatment efficiency between the two groups (P = 0.258).

Conclusion: This study demonstrated that the diagnosis of otomycosis requires vigilance from clinicians given its nonspecific or minor symptoms. Both ear canal rinses and local antifungal creams are effective, and sequential treatment via both methods is reasonable.