Fungal ear infection

An explanation of the different types of ear infection and which parts of the ear are involved can be found in the separate leaflet called Ear infection (otitis media).

This leaflet is about infection of the ear canal (otitis externa) with a fungus. Other causes of otitis externa can be found in the separate leaflet called Otitis externa and painful, discharging ears.

What does a fungal ear infection look like?

Typically, with a fungal ear infection the ear may start to itch and become painful. You may notice discharge leaking out of the ear. The ear usually feels full and the hearing may feel muffled on the affected side.

The itch is often much worse than with other types of ear infection. Apart from this, the symptoms of a fungal ear infection are often identical to outer ear infections caused by germs (bacteria).

Fungal infection of the ear is more common in people living in tropical countries, and in people who do a lot of water sports such as scuba diving, swimming and surfing. It occurs more often in the summer months than the winter.

Earwax (cerumen) protects the lining of the ear from fungus so anything that reduces the amount of wax (such as sea water splashing into the ear canal or the use of cotton ear buds), may allow a fungal ear infection to take hold. Skin conditions such as eczema inside the ear can be another risk factor.

The outside temperature plays a significant part. Fungi grow faster in the heat, so it's more common in warmer climates. In the UK it occurs more often in summer than in winter.

9 out of 10 fungal infections are due to a fungus belonging to the Aspergillus species and the rest are caused by a fungus of the Candida species.

Because a fungal infection can look very similar to an ear canal infection caused by bacteria, it may only be suspected if the infection does not improve with drops typically prescribed for a bacterial infection.

It may also be suspected from the appearance of the ear canal (some fungal infections can cause little black dots surrounded by a cotton-like material, known as spores, to form in the ear canal), or if you are more prone to fungal infections because your immune system isn't working properly.

The diagnosis is usually confirmed by taking an ear swab and sending this to a lab for testing.

Your doctor will probably treat your ear first and take an ear swab if the condition doesn't get better. Taking an ear swab is a fairly simple procedure and involves putting a swab that looks very similar to a cotton bud in your ear and gently moving it around. This shouldn't be painful unless your ear is very tender and inflamed from the infection. Even then, gentle swabbing should only cause mild discomfort.

Fungal ear infections usually cause a fair amount of discomfort and discharge so most people see a doctor soon after the condition starts. There are some eardrops available over the counter without a prescription from pharmacies, but the best they can do is reduce the inflammation a bit. In fungal infections, they don't usually have much effect.

See a doctor sooner rather than later if:

• You are in a lot of pain.

• Your ear produces a lot of discharge.

• You feel generally unwell or develop unusual symptoms such as dizziness.

• You have a high temperature.

• The outer part of your ear looks very mucky.

• Your hearing becomes muffled.

• You've bought some treatment from the chemist which hasn't worked.

Aural toilet

If the inside of your ear looks really messy, the doctor may suggest a clean-up to allow treatment drops to be more effective. This has the odd name of aural toilet. It can be done by a doctor or more usually a nurse, usually in a hospital ear nose and throat (ENT) department.

It involves gently clearing the ear of discharge using swabs, a suction tube or syringe. This may need to be done several times a week in the first instance. Aural toileting eases discomfort and also helps ear drops to get to the right place. However, it may be a bit uncomfortable while you're having it done, and you may need to take some painkillers.

Avoid irritating your ears

Don't fiddle with your ear, keep it dry and try to avoid scratching inside, however itchy it may be, as this will stop the infection from clearing up. It's never advisable to put a cotton wool plug in the ear. Additionally, avoid swimming until the condition clears up. If you use a hearing aid or ear phones, you should refrain from using the device in the affected ear until the treatment is complete.

Aluminium acetate ear drops (Burow's solution)

Your doctor may prescribe 5% aluminium acetate ear drops. This is also known as Burow's solution. It's not an antifungal but is used to calm down inflammation and help remove any muck in your ear.

Acetic acid (EarCalm®)

A similar preparation that helps with inflammation is 2% acetic acid. This is available on prescription or can be bought from the chemist in the form of EarCalm® spray.

Antifungal ear drops

There are a number of antifungal ear drops available which may be useful, such as clotrimazole 1% ear drops or an antifungal/steroid combination such as flumetasone pivalate 0.02% plus clioquinol 1% ear drops. The exact treatment prescribed will usually be guided by the result from the ear swab.

Further treatments

If you've tried antifungal drops for a couple of weeks and you're still having problems, go back and see your doctor. You may need further investigation and/or referral to an ENT specialist, usually via an emergency clinic in the hospital. This clinic usually has access to special treatments to get the ear clean and dry, such as inserting a pack made from ribbon gauze, a wick made of sponge that hangs out of the ear and drains it or suction using a tiny tube (microsuction).

Providing you're otherwise fit and well and do not have a weakened immune system, the infection should respond fairly quickly to antifungal treatment. However, if you have a condition that makes you prone to getting repeated infections (such as diabetes or a reduced immune system due to medicine that you take for conditions such as arthritis or after a transplant) it may well come back or require a longer course of anti-fungal treatment.