ENT - September 2020 - 521

Koltsidopoulos and Skoulakis
be a prerequisite for this closure.8 On the other side, the possibility of a persistent TM defect is not insignificant. It is worth
mentioning that some authors reported quite high rate of persistent TM perforation.16
These cases are managed with tympanoplasty with good
results.6,8,16 Namely, in all patients, complete closure of the
defect was achieved. The only residual hearing loss was in a
case with almost total disintegration of the tympanic
membrane.8
The duration of follow-up before performing tympanoplasty
differs between studies. Namely, Hurst et al performed tympanoplasty in cases that failed to heal within a month.8 On the
other hand Song et al followed patients for at least 3 months
before proceeding with a surgical intervention.16

Conclusions
Based on the available literature, it seems that tympanic membrane perforation associated with otomycosis is not uncommon. Otolaryngologists and even primary care physicians
should be aware of this clinical feature of fungal otitis externa.
The main difficulty in managing this condition is the fact that
the seepage of topical antifungal ear drops to the middle ear
cavity may cause intense pain and severe burning sensation.
Additionally, some antifungal agents may be ototoxic. Most of
the perforations secondary to otomycosis tend to resolve with
medical treatment, but some persist and require tympanoplasty.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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