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      A search for new otomycotic species and their sensitivity to different antifungals

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          Abstract

          Background

          Otomycosis is a common ear problem in countries with hot and humid climate. Emergence of new fungal species is a possibility particularly in patients with chronic illness or who receives antibiotics either systemically or topically.

          Aim

          To identify the otomycotic species, which are responsible for developing the otomycosis.

          Methods

          A descriptive study was carried out in 63 patients who were clinically diagnosed with otomycosis. Swabs were taken from the fungal debris to identify the causative agent and to determine the effective antifungals against it.

          Results

          Aspergillus species were the most common agents and were found in 47 patients (74.6%), represented by A. fumigatus (36.5%), A. niger (27%), A. flavus (6.5%), and A. terreus (4.8%). Ketoconazole (90%) and miconazole (76%) were the most effective antifungals against the species obtained from cultures, whereas fluconazole was the least effective.

          Conclusions

          Although there is no change in the mycology of otomycosis, there is still a significant variability in the isolated species and in their sensitivity to antifungal drugs. Ketoconazole exhibited broad spectrum effect against fungal isolates in this study, whereas fluconazole was the least efficacious.

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          Most cited references18

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          Ototopical antifungals and otomycosis: a review.

          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.
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            Otomycosis in Shanghai: aetiology, clinical features and therapy.

            Otomycosis is frequently seen in Shanghai and is a challenging problem due to recurrence and resistance to therapy. The aims of this study were to determine the pattern of fungal agents, sex distribution, clinical presentation, predisposing factors, complications and treatment outcomes of otomycosis. Retrospective review of 108 patients with a clinical diagnosis of otomycosis treated from September 2009 to September 2010 in otolaryngology outpatient department. It has been found to be more prevalent in female patients than male patients with a sex ratio (F : M) of 2 : 1. Aspergillus niger (54.78%) followed by Candida albicans (16.52%) were the dominant fungi. Pruritus and otorrhea were the most common presenting complaints. The predisposing factors included frequent scratching of the external ear canal (79.63%), taking ototopical and/or oral antimicrobials (24.07%), diabetes (11.11%) and otologic procedures (7.41%). Residual disease was observed in 9.26% and recurrence in 8.89% of the subjects. Topical Fluconazole ear drops and mechanical debridement of visible fungal elements in the external auditory canal were all relatively effective with 83.33% resolution rate on initial application. The diagnosis of otomycosis requires vigilance from clinicians given its non-specific symptoms. Sometimes mycological examinations are necessary. Treatment regimens such as topical fluconazole coupled with mechanical debridement are generally effective. However, recurrence is not uncommon and eradication of disease can be particularly difficult in patients with diabetes and a mastoid cavity.
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              Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

              Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.
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                Author and article information

                Journal
                imas
                IMAS
                Interventional Medicine and Applied Science
                IMAS
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                26 June 2018
                September 2018
                : 10
                : 3
                : 145-149
                Affiliations
                [ 1 ]Faculty of Medicine, Department of Otolaryngology, Suez Canal University , Ismailia, Egypt
                [ 2 ]Faculty of Medicine, Department of Microbiology and Immunology, Suez Canal University , Ismailia, Egypt
                [ 3 ]Resident of Otolaryngology, Al-agouza Police Hospital , Al-agouza, Egypt
                Author notes
                [* ]Corresponding author: Mohammed Rifaat Ahmed; Faculty of Medicine, Department of Otolaryngology, Suez Canal University, Ismailia ‎41511, Egypt; Phone: +20 12 85043825; Fax: +20 66 3415603; E-mail: m_rifaat@ 123456hotmail.com
                Article
                10.1556/1646.10.2018.28
                6343575
                baf7d72c-0bbd-46cb-acb8-9d1e81d7cdf6
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 16 July 2017
                : 08 May 2018
                : 15 May 2018
                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 16, Pages: 5
                Funding
                Funding sources: None.
                Categories
                ORIGINAL PAPER

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                etiology,antifungals,otomycosis,treatment,culture

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