Otomycosis complicated by invasive otitis externa represents a serious presentation that goes well beyond routine ear canal fungal infection. The invasive form demands a substantially more aggressive management strategy than standard topical therapy.
This protocol addresses otomycosis occurring in the setting of invasive otitis externa — a presentation where systemic antifungal intervention becomes essential and topical agents alone are not sufficient.
Aggressive management is required, combining surgical and systemic antifungal components. The complete protocol — including agent selection, alternatives, and clinical decision points — is available via the link below.
DOI: 10.22541/au.170670973.33825129/v1
Systemic antifungals have an important role in specific cases of otomycosis, for example in immunosuppressed patients unresponsive to topical antifungals, in multi-drug resistant Candida auris and Aspergillus infections and in invasive otitis externa.
In one case of invasive otitis externa affecting a female diabetic patient, Aspergillus niger, resistant to several topical agents, was treated effectively with intravenous voriconazole.
A rare case of otomycosis in a healthy male patient caused by Lichtheimia corymbifera was treated aggressively with debridement of devitalised tissue and a prolonged course of intravenous amphotericin B.
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