ENT - September 2020 - 518

Scholarly Review

Otomycosis With Tympanic Membrane
Perforation: A Review of the Literature

Ear, Nose & Throat Journal
2020, Vol. 99(8) 518-521
ª The Author(s) 2019
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DOI: 10.1177/0145561319851499
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Petros Koltsidopoulos, MD, PhD1, and Charalampos Skoulakis, MD, PhD2

Abstract
Objective: The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with
otomycosis and to discuss the literature regarding the difficulties in managing this condition. Data Sources: Literature review
from 1999 to 2019, Web of Science, PubMed, and Medline. Study Selection: We searched for eligible articles concerning the
clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of
articles included for this review. Data Extraction: All the articles described in the study selection were used for this review.
Data Synthesis: Statistical techniques were not used. Conclusion: Based on the available literature, it seems that tympanic
membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused
tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.
Keywords
otomycosis, fungal otitis externa, tympanic membrane perforation, tympanoplasty

Introduction

Materials and Methods

Otomycosis is a superficial fungal infection of the external ear
canal that is frequently seen in primary care and otolaryngology practices. It is a worldwide disease, but is more prevalent
in the warm, humid climate.1 There has been an increase in the
prevalence of otomycosis in recent years due to the extensive
use of antibiotic eardrops.2,3 Other predisposing factors for the
development of otomycosis are frequent swimming, an immunocompromised host (eg, diabetic mellitus, acquired immune
deficiency syndrome), pregnancy, postcanal wall down mastoidectomy, tympanic membrane perforation, hearing aid wearing, and self-inflicted injuries (eg, by cotton swabs).4 Diagnosis
is mostly clinical, and Aspergillus and Candida species are the
most commonly identified fungal pathogens.5 Fungal pathogens have been reported to cause 9% of all cases of otitis
externa, but this figure appears to be on the rise, presumably
because of the increased use of topical antibiotics.6 Treatment
recommendations include local debridement along with antifungal medication, either local or systemic.7 An infrequently
reported complication of otomycosis is tympanic membrane
perforation.8 In a clinical study by Ram Kumar, the incidence
of tympanic membrane perforation in otomycosis was found to
be 11%, and perforation was more common with otomycosis
caused by Candida albicans.9
The objective of the present review was to assess the rate of
tympanic membrane perforation in patients with otomycosis
and to discuss the literature regarding the difficulties in therapy
associated with this pathology.

We searched PubMed and MEDLINE databases from 1999 to
2019 for original articles and case series concerning the clinical
entity of tympanic membrane perforation secondary to otomycosis. Only articles published in English were reviewed.
The following search terms were used: otomycosis, fungal
otitis externa, tympanic membrane perforation, tympanoplasty,
and myringoplasty. Limiting search terms were case series and
clinical trial. Additional articles were identified by handsearching the reference lists of the retrieved articles. Cases
reports describing patients with tympanic perforation caused
by otomycosis were excluded. Two authors (P.K. and E.P.)
independently graded the articles for eligibility criteria, and
any disagreement was resolved by discussion. Analysis of the
literature did not permit a systematic review to be performed
because the studies included were heterogeneous and were not
designed to answer our main question.

1
2

Department of Otolaryngology, General Hospital of Volos, Volos, Greece
Department of Otolaryngology, University Hospital of Larissa, Larissa,
Greece

Received: March 24, 2019; accepted: April 26, 2019
Corresponding Author:
Petros Koltsidopoulos, MD, PhD, Department of Otolaryngology, General
Hospital of Volos, Polimeri 134, 38222, Volos, Greece.
Email: petkoltsid@yahoo.gr


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ENT - September 2020

Table of Contents for the Digital Edition of ENT - September 2020

The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - Intro
ENT - September 2020 - Cover1
ENT - September 2020 - Cover2
ENT - September 2020 - 489
ENT - September 2020 - 490
ENT - September 2020 - 491
ENT - September 2020 - 492
ENT - September 2020 - 493
ENT - September 2020 - 494
ENT - September 2020 - 495
ENT - September 2020 - 496
ENT - September 2020 - 497
ENT - September 2020 - 498
ENT - September 2020 - 499
ENT - September 2020 - 500
ENT - September 2020 - The Creation of a Sustainable Otolaryngology Department in Malawi Nathan Douglas Vandjelovic, Eric Masao Sugihara, Wakisa Mulwafu, and David Nathan Madgy
ENT - September 2020 - 502
ENT - September 2020 - Hazardous Grilling Due to Wire Brushes Nima A. Vahidi, Brenna A. Keane, Paul J. Whalen, and Anita Jeyakumar
ENT - September 2020 - 504
ENT - September 2020 - Guns n’ Noses: Endoscopic Removal of an Air-Gun Pellet Retained in the Frontal Sinus Dylan A. Levy, Andrew Y. Lee, Waleed M. Abuzeid, and Nadeem A. Akbar
ENT - September 2020 - 506
ENT - September 2020 - 507
ENT - September 2020 - Vitamin D Status in Egyptian Children With Allergic Rhinitis Khaled Saad, Abobakr Abdelmoghny, Mohamed Diab Aboul-Khair, Yasser Farouk Abdel-Raheem, Eman Fathalla Gad, Ahmed El-Sayed Hammour, Bahaa Hawary, Asmaa M. Zahran, Mohamd A. Alblihed, and Amira Elhoufey
ENT - September 2020 - 509
ENT - September 2020 - 510
ENT - September 2020 - 511
ENT - September 2020 - 512
ENT - September 2020 - Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017 Ying-Xia Lu, Jie-Qiong Liang, Qing-Long Gu, Chong Pang, and Chun-Lei Huang
ENT - September 2020 - 514
ENT - September 2020 - 515
ENT - September 2020 - 516
ENT - September 2020 - 517
ENT - September 2020 - Otomycosis With Tympanic Membrane Perforation: A Review of the Literature Petros Koltsidopoulos and Charalampos Skoulakis
ENT - September 2020 - 519
ENT - September 2020 - 520
ENT - September 2020 - 521
ENT - September 2020 - Simultaneous Bilateral Same-Day Endoscopic Myringoplasty Using Tragal Cartilage From One Ear Baklaci Deniz, Kuzucu Ihsan, Guler Ismail, Kum Rauf Oguzhan, and Ozcan Muge
ENT - September 2020 - 523
ENT - September 2020 - 524
ENT - September 2020 - 525
ENT - September 2020 - 526
ENT - September 2020 - 527
ENT - September 2020 - A Preliminary Report on the Investigation of Prestin as a Biomarker for Idiopathic Sudden Sensorineural Hearing Loss Changling Sun, Xiaolin Xuan, Zhi Zhou, Yuan Yuan, and Fei Xue
ENT - September 2020 - 529
ENT - September 2020 - 530
ENT - September 2020 - 531
ENT - September 2020 - A Retrospective Study to Identify the Relationship Between the Dimension of Osseous External Auditory Canal and Chronic Otitis Media Yi-Fang Lee, Pei-Yin Wei, Chia-Huei Chu, Wen-Huei Liao, An-Suey Shiao, and Mao-Che Wang
ENT - September 2020 - 533
ENT - September 2020 - 534
ENT - September 2020 - 535
ENT - September 2020 - 536
ENT - September 2020 - Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome Burak Kersin, Murat Karaman, Engin Aynacı, and Ahmet Keles
ENT - September 2020 - 538
ENT - September 2020 - 539
ENT - September 2020 - 540
ENT - September 2020 - 541
ENT - September 2020 - 542
ENT - September 2020 - Changing Trends of Color of Different Laryngeal Regions in Laryngopharyngeal Reflux Disease Chen Du, Paige Thayer, Yan Yan, Qingsong Liu, Li Wang, and Jack Jiang
ENT - September 2020 - 544
ENT - September 2020 - 545
ENT - September 2020 - 546
ENT - September 2020 - 547
ENT - September 2020 - 548
ENT - September 2020 - 549
ENT - September 2020 - 550
ENT - September 2020 - 551
ENT - September 2020 - 552
ENT - September 2020 - Cover3
ENT - September 2020 - Cover4
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