Fungal ear infection hearing loss,clip earrings qvc,what does the ringing sound in your ears mean superstition,ear infection and discharge - Step 2

Fungal infections of the external ear (Otomycosis- also known as Singapore Ear) are common clinical problem encountered in the ENT practice, especially in hot and humid climatic conditions.
The common fungus encountered are Aspergillus-niger and fumigatus and also Candida albicans.
The ear canal can be easily infected because it is dark and warm, hence bacteria or fungus may grow there, because of high humidity and moisture.
Otomycosis most often occurs when too much water gets in the ear canal such as after swimming or showering in chlorinated water. Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia.
In general terms otitis externa (commonly called  swimmers ear) is an inflammation of the skin of the auditory canal.
In order to understand otitis externa, understanding the anatomy and physiology of the external auditory canal is important. The external auditory canal is comprised of cartilaginous and bony segments.  The skin covering the external cartilaginous component is thick, hair bearing and produces cerumen (wax), with cerumen acting as both a waterproofing  as well as an antibacterial and antifungal agent. Note the severe swelling causing occlusion of the external auditory canal, with only a minimal degree of discharge seen. Fungi are responsible for approximately 10% of cases with Aspergillus species the most prominent.
Post treatment fungal colonisation and chronic fungal otitis externa are not uncommon entities. Correct diagnosis: especially in children there is a often a difficulty in determining whether a presentation of otalgia is the result of otitis externa or of the more common acute otitis media, especially if this is associated with a tympanic membrane perforation. Ear toilet: the commonest cause of treatment failure is inability to apply topical therapy. Severe swelling of the canal: Oral antibiotics and a short course oral steroids can allow initial resolution of swelling then allowing topical therapy to be more effective.

Referral for microscopic toilet: this allows effective removal of debris and purulent discharge. Insertion of a wick: a self expanding wick inserted into a narrowed canal allows delivery of topical therapy with continuous exposure to the antimicrobial agent.
Malignant otitis externa (skull base osteomyelitis): essentially isolated to the immunocompromised.
Water precautions: for those prone to recurrent infections the use of cotton wool with Vaseline in the bath and shower, and fitted ear plugs for swimming.
Simple intermittent use of olive oil drops can be very useful for minimising wax buildup, dryness and itching. External auditory canal shows edema, and black discharge, at time like wet tissue paper in the ear. Clean the ear canal by vacuum suction under an operating microscope using normal saline at body temperature. Avoid swimming, or water getting into the ear until the fungal infection is fully eradicated. Turn your head to each side and pull the earlobe in different directions to help water run out.
This is usually a primary infection, but can occur as the result of discharge from the middle ear.
Whilst most OE is generalised less commonly a furuncle can form in association with a hair follicle. Without access to a suction device and a microscope, the use of a cotton wool ball fashioned into a spear can allow removal of a degree of discharge from the ear canal.
The important components of this therapy are the acidity and anti-inflammatory components as well their the anti-microbial activity.
The use of topical steroids and resolution of the infection are critical but systemic use of NSAIDs and paractemol is also important.

The fact that pseudomonas represents the commonest bacterial cause of OE does represent problems in selecting an appropriate agent, given that oral ciprofloxacin is problematic in the paediatric setting. It also allows exclusion of the presence of a foreign body (always a consideration in children). This is usually removed at 48-72 hours.Another option for difficult cases is the instillation of anti-microbial, anti-fungal and anti-inflammatory ointments to fill the canal under direct microscopic guidance. When retained water is suspected, the intermittent use of a alcohol based drop such as Swimmers ear drops is useful.
Atopic dermatitis, contact dermatitis (including that to components of topical therapy) , psoriasis amongst others should always be considered. A hair dryer set on the lowest speed and heat can also help dry ears, but be sure to hold it several inches from your ear. If you are confident that the tympanic membrane is intact, sofradex is the first line therapy.
Topical steroids are often indicated and the use of hypoallergenic skin and hair products recommended. After swimming in common pool, put few drops of acetic acid ear drops or any other antifungal ear drops. Ideally therefore microscopic toilet with a suction aspirator is required, and this may be needed every couple of days. A ciprofloxacin based drop should be used when a tympanic membrane perforation is a possibility.

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30.09.2014 admin

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