What Is a Fungal Ear Infection or Otomycosis?

A fungal ear infection, also called otomycosis, is an infection of the outer ear that is caused by a fungus.

Fungal infections of the ear canal are by far the most common form of otomycosis, but it can affect any part of the ear. They typically occur in one ear at a time.

This article will go over what causes a fungal ear infection, what the symptoms are, how it’s diagnosed, and how it can be treated and prevented. 

Fungal Ear Infection Symptoms

A fungal ear infection can affect the outer ear canal as well as the parts of the outer ear: the tragus, helix, and lobule (earlobe).

Symptoms of a fungal ear infection include:

• Itching
• Ear pain
• Ear discharge that can vary in color (yellow, white, gray, brown, or green)
• Hearing loss
• Ringing in the ears (tinnitus)

Your ears may also get red, swollen, and inflamed. The skin of your affected ear may become flaky.

Causes

The cause of a fungal ear infection is a fungus. There are many different kinds of fungi that can infect the ear, but the two most common are Candida and Aspergillus.

Candida causes most yeast infections. Aspergillus can lead to allergic reactions, lung infections, and infections in other organs.

Risk Factors

Although people come into contact with fungi on a regular—even daily—basis, most do not have any health problems related to fungus. However, people with weakened immune systems are more likely to get fungal infections.

Health Conditions

Having certain health conditions can increase your chances of getting a fungal ear infection, including:

• Diabetes
• Cancer such as lymphoma
• HIV/AIDS
• Eczema or other skin conditions
• Recent organ transplant 
• Getting chemotherapy or radiation therapy
• A weekend immune system for another reason

Other Causes and Risk Factors

Research has shown that some lifestyle or geographical factors may also play a role in who gets fungal ear infections. 

For example, because fungi thrive in warm and damp places, people living in tropical climates where humidity is high are likely to be more at risk for fungal ear infections.

Other factors that can increase the risk of a fungal ear infection include:

• How much wax is in the ear
• Ear trauma caused by hearing aids or cotton swabs
• Swimming, surfing, or other water sports
• Frequent use of medications, such as topical antibiotics or steroids

Diagnosis

To determine if the ear infection is caused by a fungus, your provider will go over your medical history and any symptoms you have. 

They will also do a physical exam using an otoscope, a lighted device used to get a better look inside the ear. They will look for signs of infection in the ear canal and eardrum.

If your ear has fluid, discharge, or any other type of buildup in it, your provider will take a sample and send it to a lab. This testing helps them find out whether the ear infection is bacterial or fungal. 

Both infections have similar symptoms, but knowing what is causing the ear infection will make treatment more effective.

More involved tests like cultures are often not needed because fungal infections usually look a certain way.

Treatment

There are many treatments for fungal ear infections, but the one that’s right for you depends on your health and how serious the infection is.

Cleaning

The first step in the treatment of a fungal ear infection is clearing debris out of the ear. There are different tools a provider can use, including a rinse or a suction tool.

Clearing out your ear makes sure that the medication can do its job. Once your provider removes the buildup in the ear, they will clean and dry your ear to help prevent the overgrowth of fungus from coming back.

Ear Drops

Antifungal ear drops for fungal ear infections are usually clotrimazole. 

However, other types of medications such as econazole, miconazole, and amphotericin B can also be used.

Clotrimazole is effective at both curing the infection and preventing it from coming back.

Topical Medications

If the infection is affecting the inside of the outer ear and the external parts, an antifungal topical ointment can help clear up the fungus and reduce symptoms.

Topical medications for these infections include clotrimazole, fluconazole, and ketoconazole.

Research has shown that solutions with 2% acetic acid plus 90 cubic centimeters (cc) of 70% isopropyl alcohol might effectively treat a fungal ear infection.

Oral Medications

If a fungal ear infection does not get better with topical treatments or ear drops, your provider may prescribe an oral medication, especially if Aspergillus is causing the infection. Research has shown that this type of fungus might be resistant to azole compounds.  

Over-the-counter (OTC) medications can help with the pain and inflammation of a fungal ear infection. 

Oral prescription medications are usually needed if the infection is severe or takes longer than expected to heal.

The length of treatment for a fungal ear infection can last up to four weeks. During this time, your symptoms will continue to improve while the medications work to clear up the infection.

Complications

A fungal ear infection is not usually a serious condition, but there are some rare cases where it can lead to complications including:

• A ruptured eardrum
• Hearing loss
• An infection in the temporal bones at the sides and base of the skull
• Fungal mastoiditis (inflammation of the bone that is beside the ear)
• Inflammation of the brain (encephalitis)

Although complications are rare, they can be serious or even life-threatening. If you think you have a fungal ear infection, see your provider to get diagnosed and start treatment as soon as possible to prevent these complications.

Prevention

The best ways to prevent a fungal ear infection are:

• Keeping a small amount of wax in your ear to help keep fungus out
• Using earplugs when you’re swimming
• Drying your ears thoroughly with a clean tissue after bathing and swimming or use a hair dryer on a low, cool setting
• Being careful not to scratch the skin surrounding the ears or inside the ear
• Do not put cotton swabs or anything else in your ears

Coping

A fungal ear infection can be uncomfortable but is usually temporary. Once you see your provider and get diagnosed and start treatment, you should start feeling better. 

In addition to taking any medications your provider has given you and OTC remedies for pain, you might want to try some simple home remedies, like a warm compress, to relieve discomfort. 

Summary

A fungal ear infection is caused by fungus. You're more likely to get this kind of ear infection if you have a weak immune system or do activities in the water like swimming.

You can’t always prevent a fungal ear infection but not using anything in your ear (like a cotton swab) and making sure your ears stay dry and clean will help. 

If you have symptoms of a fungal ear infection, you need to see a healthcare provider for treatment. While you wait for the infection to clear up with treatment, you might be able to manage the discomfort at home with OTC pain relievers.