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1

Lecanu, J. B., M. Erminy, P. Faulcon, and B. Théoleyre. "Otomycose." EMC - Oto-rhino-laryngologie 3, no. 4 (2008): 1–8. http://dx.doi.org/10.1016/s0246-0351(08)46827-7.

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2

Zaror, Luis, O. Fischman, F. A. Suzuki, and R. G. Felipe. "Otomycosis in São Paulo." Revista do Instituto de Medicina Tropical de São Paulo 33, no. 3 (1991): 169–73. http://dx.doi.org/10.1590/s0036-46651991000300001.

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In view of the lack of researches on otomycoses in Brazil, we have tried to study their incidence, their clinical characteristics and the predisponent factors During one year, 22 suspected cases were seen, 20 of them corresponded to otomycosis infections. The most frequent species were Aspergillus niger (35%) and Candida albicans (20%). The genus Aspergillus represented 75% of the isolates. Itching and hyperaemia (70%), otalgia (65%), hipoacusia (50%) were the commonest signs. Lack of cerumen (70%) chronic otitis (30%) previous antibiotic therapy and eczema (25%) were the most outstanding predisponent factors.
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3

Bakshi, Satvinder Singh, and Soumyajit Das. "Otomycosis." Medicina Clínica 155, no. 10 (2020): 472. http://dx.doi.org/10.1016/j.medcli.2019.08.003.

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4

Bakshi, Satvinder Singh, and Soumyajit Das. "Otomycosis." Medicina Clínica (English Edition) 155, no. 10 (2020): 472. http://dx.doi.org/10.1016/j.medcle.2019.08.010.

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5

Pulec, Jack L., and Christian Deguine. "Otomycosis." Ear, Nose & Throat Journal 81, no. 6 (2002): 370. http://dx.doi.org/10.1177/014556130208100602.

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6

MALIK, MUHAMMAD FAHIM, RASHID ZIA, and SAJJAD AKRAM. "OTOMYCOSIS." Professional Medical Journal 16, no. 03 (2009): 419–23. http://dx.doi.org/10.29309/tpmj/2009.16.03.2870.

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b j e c t i v e s : To determine the efficacy of tincture mertheolate in otomycosis. Design: An experimental study. Setting:Department of ENT Allama Iqbal Medical College/ Jinnah Hospital, Lahore. Period: From Dec. 2007 to April 2008. Patients & M e t h o d s A totalof 60 patients of symptomatic otomycosis were investigated prospectively. Aural swabs were collected on first, 7th and 14th day and examined,by direct microscopy of external auditory canal and culture for fungi. Of these 60 patients found to be having pure fungal infection were takenup for mycological and therapeutic study. Results Fungi belonging to Aspergillus were isolated in 57(95%) patients of which Aspergillus nigerwas the commonest isolated in 34(56.6%) patients followed by Aspergillus flavus in 21(35%) and Aspergillus fumigates in 2(3.33). Candidaspecies in 2(3.3%) and Mucor in 1 (1.6%) of patients. The patients were of all age groups but majority were between 21 and 30 years and themale to female ratio was equal. No patient had fungal infection elsewhere in the body. The patients were called for regular follow-up for threeweeks. In 30 cases tincture mertheolate was applied as topical antifungal agent after cleaning the external auditory canal, in 17 patient'sclotrimazole and in rest of the 13 patients miconazole was used. On 7th day, only 8 (13.3%) patients grew fungi in culture. They becamesymptom free on 14th day and no fungal material could be seen on otoscopy, direct microscopy or culture. Tincture mertheolate was found tobe most effective in these patients.
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7

Kiakojuri, Keyvan, Ramazan Rajabnia, Saeid Mahdavi Omran, Abazar Pournajaf, Mohsen Karami, and Mojtaba Taghizadeh Armaki. "Role of Clotrimazole in Prevention of Recurrent Otomycosis." BioMed Research International 2019 (December 26, 2019): 1–6. http://dx.doi.org/10.1155/2019/5269535.

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Otomycosis is one of the relatively common diseases in the world which is caused by different fungi especially saprophytes. Concerning the relapse of this disease in a number of individuals, the present study was performed to evaluate the inhibitory effect of clotrimazole drop in the relapse of otomycosis. Clinical samples were taken by an ENT specialist from patients suspicious of having otomycosis. A part of these samples were stained, and others were cultured. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae or mycelium and fruiting bodies and/or conidiophores under microscopic examination. Patients with suspected otomycosis are not at risk of recurrence after treatment with clotrimazole drops. Out of the 161 individuals in whom definite diagnosis of otomycosis was made, the most affected individuals were, in the age range of 40–49 years, women, urban citizens, and housewives. Pruritus and diminished hearing were the main complaints of the patients. Aspergillus niger and A. flavus as well as Candida albicans were the main causes of the disease. The relapse of disease was observed in only five patients (3.1%), where A. niger was the main fungus. Most relapses were observed in women and in those with diminished hearing, manipulating the ears, ulcers in the canal, and tympanum. Our results suggested that usage of clotrimazole can be effective in reducing the relapse of otomycosis, and concerning the high cost of treating otomycosis while the low cost of using clotrimazole, usage of this drop is recommended to reduce the relapse of otomycosis.
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8

Prasad, Sampath Chandra, Subbannayya Kotigadde, Manisha Shekhar, et al. "Primary Otomycosis in the Indian Subcontinent: Predisposing Factors, Microbiology, and Classification." International Journal of Microbiology 2014 (2014): 1–9. http://dx.doi.org/10.1155/2014/636493.

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Objective. To define otomycosis and determine the predisposing factors and microbiology in primary otomycosis.Study Design. Prospective study of two years and review of the literature.Setting. Academic Department of Otolaryngology in a coastal city in India.Patients. 150 immunocompetent individuals of whom 100 consecutive patients with a clinical diagnosis of otomycosis are considered as the study group and 50 consecutive patients with no otomycosis are considered as the control group.Results and Observations. Instillation of coconut oil (42%), use of topical antibiotic eardrops (20%), and compulsive cleaning of external ear with hard objects (32%) appeared to be the main predisposing factors in otomycosis. Aspergilli were the most common isolates (80%) followed byPenicillium(8%),Candida albicans(4%),Rhizopus(1%), andChrysosporium(1%), the last being reported for the first time in otomycosis. Among aspergilli,A. nigercomplex (38%) was the most common followed byA. fumigatuscomplex (27%) andA. flavuscomplex (15%). Bacterial isolates associated with fungi in otomycosis wereS. aureus,P. aeruginosa, andProteusspp. In 42% of healthy external ears fungi were isolated.Conclusion.Aspergillusspp. were the most common fungi isolated, followed byPenicillium. Otomycotic ears are often associated with bacterial isolates when compared to normal ears. Fungi are also present in a significant number of healthy external auditory canals and their profiles match those in cases of otomycosis. The use of terms “primary” and “secondary” otomycosis is important to standardize reporting.
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9

Yang, Chunhui. "Tympanic membrane perforation, otitis media and labyrinthitis caused by otomycosis confirmed by intravenous gadolinium 1.5 tesla MRI-a case report." MOJ Clinical & Medical Case Reports 11, no. 1 (2021): 1–3. http://dx.doi.org/10.15406/mojcr.2021.11.00369.

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Otomycosis is a fungal ear infection, mostly a superficial mycotic infection of the outer ear canal. The infection may be either subacute or acute but chronic form is around 10%. The characteristic of otomycosis are discharge, pruritus, or more severe discomfort. Here we report a 46-year-old Asian woman presented with vertigo and was diagnosed as otomycosis with the complications of tympanic membrane perforation, otitis media and labyrinthitis of inner ear which was confirmed by IV-Gd 1.5 T MRI. This case is a chronic otomycosis related to cerumen removal two year before this onset. Our study supported the suggestion that otomycosis should include fungal infections of the middle and inner ear, furthermore the infection of the inner ear may be included as labyrinthitis with the symptom of vertigo.
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10

Nipa, KK, AHM Kamal, and A. Imtiaj. "Prevalence and Clinicomycological studies of Otomycosis: A review." Journal of Bio-Science 28 (December 28, 2019): 121–35. http://dx.doi.org/10.3329/jbs.v28i0.44718.

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Otomycosis is a chronic ear disease of external auditory canal and it is more prevalent in warm, humid and dusty environment, although it is now found throughout the world. The most commonly found causative agents as of fungal species are Aspergillus and Candida along with preponderance of various fungal and bacterial species has also been reported. The aim of this review is to focus on the prevalence of causal agents of otomycosis in the global context and its clinical management. A total of 63 research articles have been reviewed, which deals prevalence of otomycosis. Its clinicomycological studies both separately and altogether with folk medicine in relation to treatment of otomycosis were also reviewed. Findings of various reports revealed that the Aspergillus and Candida species are the main causal agents of otomycosis. But many reports indicate that a few of other fungal species along with bacteria particularly Staplylococcus aureus and Pseudomonas aeruginosa are also responsible for accelerating this disease in human all over the world. In many reports, improper self-cleaning of ear has been found as major predisposing factor of otomycosis. This review suggests that health education, improvement of socioeconomic status and health caring facilities should be increased for reducing prevalence of otomycosis. However, more research needs to be carried out because of its severe parallel effects to the human health.
 J. bio-sci. 28: 121-135, 2020
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11

Pak, Martin Wai, Gordon Soo, and Charles Andrew van Hasselt. "Flourishing Otomycosis." Ear, Nose & Throat Journal 76, no. 1 (1997): 10. http://dx.doi.org/10.1177/014556139707600102.

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12

Arsovic, N. A., A. V. Banko, M. V. Dimitrijevic, V. Z. Djordjevic, J. P. Milovanovic, and V. A. Arsenijevic. "Protease activities of Candida spp. isolated from otitis externa: Preliminary result." Acta chirurgica Iugoslavica 56, no. 3 (2009): 113–16. http://dx.doi.org/10.2298/aci0903113a.

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Otomycosis is a fungal infection of the ear predominantly caused by Candida and Aspergillus spp. The possible virulence factors of Candida spp. are enzymes, such as proteases, phospholipases, phosphatases and esterase. According to our knowledge, protease production in Candida strains isolated from patients with otomycosis has not been investigated. The present study was aimed at determining in vitro protease activity in 8 strains of Candida spp. (C. parapsilosis, C. famata, C. guilliermondii and C. albicans) isolated from children with otomycosis. A majority of isolated strains 7/8 (87.5%) were protease positive. The protease activity ranged from Pz 0.61 to 0.78. Further investigation is necessary to clarify the contribution of protease production to Candida virulence associated with otomycosis.
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13

Arsenijevic-Arsic, Valentina, Nenad Arsovic, Aleksandar Dzamic, Andreja Trpkovic, Ivana Zec-Kranjcic, and Vojko Djukic. "Protease activities of Candida spp. isolated from immunocompetent patients with otomycosis." Jugoslovenska medicinska biohemija 23, no. 2 (2004): 171–74. http://dx.doi.org/10.2298/jmh0402171a.

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Otomycosis is a fungal infection of the ear dominantly caused by Candida and Aspergillus spp. The possible virulence factors of Candida spp. are enzymes, such as proteases, phospholipases, phosphatases and esterase. Protease production in Candida strains isolated from patients with otomycosis is, according to our knowledge, not investigated. The present study was aimed at determining in vitro protease activity in 28 strains of Candida spp. (C. parapsilosis, C. famata, C. guilliermondii, C. albicans and C. kefyr) isolated from patients with otomycosis. The majority of isolated strains 25/28 (89.28%) were protease positive. The protease Pz ranged from 0.691 to 0.851. The futher investigation is necessary to clarify contribution of protease production to Candida virulence associated with otomycosis.
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14

Westby, D., N. O'Connell, J. Powell, and J. E. Fenton. "The changing nature of paediatric otomycosis in the mid-west of Ireland." Journal of Laryngology & Otology 134, no. 7 (2020): 592–96. http://dx.doi.org/10.1017/s0022215120001164.

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AbstractBackgroundFungal otitis externa is prevalent in tropical and sub-tropical climates; however, over the past two decades, there has been a reported increase in the prevalence of otomycosis in paediatric patients from more temperate climates. This study aimed to review the children diagnosed with otomycosis at the University Hospital Limerick with reference to frequency, causative organism, predisposing factors and management.MethodsA retrospective review was conducted of paediatric patients from 2001 to 2015. Patients with positive fungal ear swabs and a diagnosis of otomycosis were identified.ResultsNinety-three patients were positive for candida (mean age, 5.8 years), 10 patients were positive for aspergillus (mean age, 9.1 years) and 1 patient had mixed fungal infection containing both fungi. There was a positive correlation between a diagnosis of otomycosis and prior treatment with topical fluoroquinolones (r = 0.8; p < 0.01).ConclusionThe incidence of otomycosis has been increasing since 2001, which correlates with an increase in the use of topical fluoroquinolones. Previous studies identify aspergillus as the commonest causative fungi; however, this study found that candida was the commonest isolated fungi in the paediatric population.
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15

&NA;. "Bifonazole for otomycoses - pilot study." Inpharma Weekly &NA;, no. 925 (1994): 14. http://dx.doi.org/10.2165/00128413-199409250-00033.

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16

MUFTIC, Mahmoud Kamal. "Mycostatin in Treatment of Otomycoses." Mycoses 1, no. 5 (2009): 156–61. http://dx.doi.org/10.1111/j.1439-0507.1958.tb04015.x.

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17

Pradhan, Bibhu, Nhuchhe Ratna Tuladhar, and Ramchaya Man Amatya. "Prevalence of Otomycosis in Outpatient Department of Otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal." Annals of Otology, Rhinology & Laryngology 112, no. 4 (2003): 384–87. http://dx.doi.org/10.1177/000348940311200416.

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Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.
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18

Philip, Ajay, Regi Thomas, Anand Job, V. Rajan Sundaresan, Shalini Anandan, and Rita Ruby Albert. "Effectiveness of 7.5 Percent Povidone Iodine in Comparison to 1 Percent Clotrimazole with Lignocaine in the Treatment of Otomycosis." ISRN Otolaryngology 2013 (July 25, 2013): 1–8. http://dx.doi.org/10.1155/2013/239730.

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Objectives. Otomycosis is a common ENT disease frequenting the tropics. Its recurrent nature poses a great challenge to the treating physician. In spite of a number of antifungals in the market, the frequent nature of this disease warrants repeated use of these drugs, contributing to drug resistance and financial burden on the rural population. Our primary aims were to evaluate the effectiveness of povidone iodine in the treatment of otomycosis and to identify the most common fungal isolate in our population. Study Design and Setting. A single blinded prospective longitudinal study was done over a period of 12 months in a tertiary referral center. 34 patients in the age group 15–70 years clinically diagnosed with otomycosis were included in this study. These individuals were divided into two groups selected randomly. One arm received 7.5% povidone iodine otic drops and the other 1% Clotrimazole and lignocaine drops. Evaluation was based on resolution of symptoms and signs after treatment. Result. Both arms showed improvements which were comparable thus suggesting the role of povidone iodine in the management of otomycosis. Conclusion. Povidone iodine is an effective antifungal in the treatment of otomycosis.
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19

Boncalon, Rhoda Mae V., Marida Arend V. Arugay, and Rachel Zita H. Ramos. "A Preliminary Study on the Efficacy of Plumeria acuminata (Kalachuchi) Bark Extract Ointment versus Clotrimazole Cream in the Treatment of Otomycosis." Philippine Journal of Otolaryngology-Head and Neck Surgery 24, no. 1 (2009): 5–8. http://dx.doi.org/10.32412/pjohns.v24i1.701.

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Objective: To compare the therapeutic efficacy of kalachuchi (Plumeria acuminata Ait.) bark extract ointment (KO) and clotrimazole cream 1% (CC) in the treatment of otomycosis.
 Methods:
 Design: Randomized double blind controlled trial
 Setting: Outpatient otorhinolaryngology clinic of a tertiary private hospital
 Subjects: Patients aged 18-years-old and above diagnosed clinically to have otomycosis with a positive potassium hydroxide (KOH) smear were randomly assigned to kalachuchi (Plumeria acuminata Ait.) bark extract ointment or clotrimazole cream 1% in unlabeled containers. Self-application thrice daily for two weeks followed initial detailed instructions and demonstration. Symptoms, physical findings and repeat KOH smears were recorded after the first and second weeks of treatment.
 Results: Eighteen patients with otomycosis were enrolled in the study. There was one dropout per treatment group with no intention to treat. There were no statistically significant differences between KO and CC, with 75% (n=8) and 87.5% (n=8) cure rates, respectively. One subject in the KO arm reported severe ear pain.
 Conclusion: Kalachuchi extract ointment may be a promising topical antifungal agent. Multicenter clinical trials to establish its efficacy and safety as an effective alternative in the management of otomycosis should be conducted.
 Key words: Otomycosis, kalachuchi, Plumeria acuminata Ait., clotrimazole, clinical trial, herbal medicine
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20

Ozcan, K. Murat, Muge Ozcan, Aydin Karaarslan, and Filiz Karaarslan. "Otomycosis in Turkey: predisposing factors, aetiology and therapy." Journal of Laryngology & Otology 117, no. 1 (2003): 39–42. http://dx.doi.org/10.1258/002221503321046621.

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Otomycosis usually requires long-term treatment and tends to recur. This study was performed on 87 patients with the clinical diagnosis of otomycosis and 20 controls in order to determine the pathogenic agents, predisposing factors and a cost-effective treatment. The predisposing factors included wearing head clothes (74.7 per cent), presence of dermatomycoses (34.5 per cent) and swimming (27.6 per cent). The most common pathogenic fungus was Aspergillus niger (44.8 per cent) in the otomycosis group. The only isolate was Candida albicans in the control group (2.5 per cent). We concluded that administration of four per cent boric acid solution in alcohol and frequent suction cleaning of the ear canal might be a cost-effective treatment for otomycosis since 77 per cent of the patients were treated effectively this way. Eighty per cent of the resistant cases had mixed fungal-bacterial infections, and 50 per cent of them had dermatomycoses. These resistant cases were treated by administration of tioconazole ointment.
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21

Viswanatha, Borlingegowda, Dadarao Sumatha, and Maliyappanahalli Siddappa Vijayashree. "Otomycosis in Immunocompetent and Immunocompromised Patients: Comparative Study and Literature Review." Ear, Nose & Throat Journal 91, no. 3 (2012): 114–21. http://dx.doi.org/10.1177/014556131209100308.

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A comparative clinical study was carried out that included 50 cases of otomycosis in immunocompetent patients and 50 cases of otomycosis in immunocompromised patients. Clinical presentation, predisposing factors, mycologic profile, and treatment outcomes were compared. Aspergillus spp were the most commonly isolated fungi in the immunocompetent group, and Candida albicans in the immunocompromised group. Bilateral involvement was more common in the immunocompromised group. All the patients were treated with topical clotrimazole ear drops. Four patients in the immunocompromised group did not respond to treatment with clotrimazole but were treated successfully with fluconazole ear drops. Three patients had a small tympanic membrane perforation due to otomycosis.
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22

Hsu, Chao-Lan, Cheng-Wei Chen, and Hua-Kung Wang. "Iatrogenic invasive otomycosis." Tzu Chi Medical Journal 23, no. 2 (2011): 66–68. http://dx.doi.org/10.1016/j.tcmj.2011.01.012.

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23

Cimolai, Nevio. "Clioquinol for Otomycosis." Otology & Neurotology 41, no. 1 (2020): 141–42. http://dx.doi.org/10.1097/mao.0000000000002513.

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24

Deguine, Christian, and Jack L. Pulec. "Otomycosis with Pus." Ear, Nose & Throat Journal 81, no. 7 (2002): 428. http://dx.doi.org/10.1177/014556130208100702.

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25

Baumgartner, Brian J., Robert M. Rakita, and Douglas D. Backous. "Scedosporium apiospermum otomycosis." American Journal of Otolaryngology 28, no. 4 (2007): 254–56. http://dx.doi.org/10.1016/j.amjoto.2006.08.017.

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26

Haruna, Shin-Ichi, Yasue Haruna, Patricia A. Schachern, Tetsuo Morizono, and Michael M. Paparella. "Histopathology update: Otomycosis." American Journal of Otolaryngology 15, no. 1 (1994): 74–78. http://dx.doi.org/10.1016/0196-0709(94)90045-0.

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27

Sheikh, Mohd S., B. Y. Qazi, and B. Rameen. "Otomycosis in Khozistan." Indian Journal of Otolaryngology and Head and Neck Surgery 45, no. 2 (1993): 73–77. http://dx.doi.org/10.1007/bf03050699.

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28

Yang, Ting-Hua, and Yi-Ho Young. "Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation." Audiology and Neurotology 24, no. 4 (2019): 183–90. http://dx.doi.org/10.1159/000501540.

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Background: Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. Objectives: The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. Methods: Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. Results: All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. Conclusion: The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.
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Lekha, V. Sneha, Neelima Priyadarshini, Siva Subba Rao Pakanati, and K. Dilip Kumar. "Mycology of otomycosis and the role of antifungal drops versus antifungal cream in the treatment of otomycosis: an observational study." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 8 (2021): 1343. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20212784.

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<p><strong>Background:</strong> Aim of the study was to determine most common mode of presentation, spectrum of fungi involved in otomycosis and to compare the treatment efficacy of 1% clotrimazole drops with 1% clotrimazole cream in management of otomycosis.</p><p><strong>Methods: </strong>A prospective observational study was conducted over a study period of 18 months, in which a total of 60 patients who are clinically diagnosed with otomycosis were included. All the specimens collected from patients were subjected to standard microbiological procedures for identification of fungi involved in otomycosis. Then patients were randomly allotted into 2 groups for treatment with 1% clotrimazole drops or with cream. Improvement in symptoms of pain, pruritis, blocked sensation, and discharge on one-and two-weeks follow-up was recorded. External auditory canal was evaluated for improvement in otomycotic debris. All patients were asked the opinion about preferred modality of treatment.</p><p><strong>Results: </strong>In our study, <em>Aspergillus niger</em> 27(45%) was the predominant species isolated. When compared to the symptoms on day 01 at day 07, significant difference was noted for the improvement of the symptoms and also for the otomycotic debris in both the groups. The group with cream had significantly more blocked sensation. On second week follow up, significant improvement was noted for all the symptoms and otomycotic debris. Forty five out of sixty patients preferred using cream.</p><p><strong>Conclusions:</strong> In our study, <em>Aspergillus </em>species was found to be the commonest fungi involved in otomycosis. 1% topical clotrimazole drops and cream were equally effective in management of otomycosis.</p>
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Ho, Hsu-Chueh, Shih-Hsuan Hsiao, Cheng-Yung Lee, and Chen-Chi Tsai. "Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review." Journal of Laryngology & Otology 128, no. 6 (2014): 547–51. http://dx.doi.org/10.1017/s0022215114001273.

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AbstractBackground:Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.Method:We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.Results:In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.Conclusion:This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.
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Sumbria, Deepshikha, Aamir Yousuf, and Rauf Ahmad. "Hospital based study on etiopathogenesis and treatment of otomycosis: ethnic Kashmiri population." International Journal of Otorhinolaryngology and Head and Neck Surgery 5, no. 5 (2019): 1190. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20193651.

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<p class="abstract"><strong>Background:</strong> Otomycosis is the fungal infection of the external ear with bothersome symptoms. The target of the study was to verify the frequency and identification of fungi responsible for the otomycosis and to give the most appropriate treatment. The aims and objectives of the study was to study clinical profile, causative fungal organisms of otomycosis, detect in vitro efficacy of various antifungal solutions against the fungi detected and to establish clinical efficacy of various topical antimycotic solutions in otomycosis in Kashmir.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in the Department of ENT, GMC, Srinagar from February 2014 to July 2015. 152 clinically suspected otomycosis patients were subjected to mycological tests including Gram staining, 10% KOH staining, GTT, SDA and CBL stain to identify the organism. Clotrimazole, terbinafine, lulliconazole, sertaconazole and combination of 1% clotrimazole, chloremphenicol, beclomethasone were given randomly in equal number of these patients. Patients were followed for 4 weeks and results of different antifungals were evaluated clinically. </p><p class="abstract"><strong>Results:</strong> Out of 152 patients 61.8% were females and most of the patients belonged to age group of 25-34 yrs.Most of the patients reported in summer season. Otalgia and itching was the most common symptom. <em>Aspergillus</em> was the most common species identified whereas <em>Candida albicans</em> was the most common individual organism isolated. Lulliconazole was most effective drug whereas combination of 1% clotrimazole, chloremphenicol, beclomethasone was least effective.</p><p class="abstract"><strong>Conclusions:</strong> Clinical suspicion of otomycosis is important to prevent unnecessary use of antibiotics. Diagnosis of otomycosis is usually made by clinical findings with pruritis being most common symptom followed by otalgia. In-vitro sensitivity test is of great importance to choose the most active antifungal agents. Patients are advised to avoid removing of ear wax by stiff materials.</p>
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Saki, N., A. Rafiei, S. Nikakhlagh, N. Amirrajab, and S. Saki. "Prevalence of otomycosis in Khouzestan Province, south-west Iran." Journal of Laryngology & Otology 127, no. 1 (2012): 25–27. http://dx.doi.org/10.1017/s0022215112002277.

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AbstractBackground:This study aimed to investigate the prevalence of otomycosis and aetiological agents in Khouzestan province, south-west Iran.Methods:This cross-sectional study examined and cultured 881 swabs from suspected external otitis cases, collected from throughout Khouzestan province. Fungal agents were identified by slide culture and complementary tests when necessary.Results:The mean patient age was 37 years. The 20–39 year age group had the highest prevalence of otomycosis: 293 cases, comprising 162 (55.3 per cent) women and 131 (44.7 per cent) men. The seasonal distribution of cases was: summer, 44.7 per cent; autumn, 28.7 per cent; winter, 14.7 per cent; and spring, 11.9 per cent. The fungal agents isolated were Aspergillus niger (67.2 per cent), Aspergillus flavus (13 per cent), Candida albicans (11.6 per cent), Aspergillus fumigatus (6.2 per cent) and penicillium species (2 per cent).Conclusion:Fungal otomycosis is still one of the most important external ear diseases. In this study in south-west Iran, Aspergillus niger was the predominant aetiological agent. However, clinicians should be cautious of candidal otomycosis, which has a lower rate of incidence but is more prevalent among 20–39 year olds.
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Ali, Khaled, Mahmood Hamed, Hameda Hassan, Amira Esmail, and Abeer Sheneef. "Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience." International Archives of Otorhinolaryngology 22, no. 04 (2018): 400–403. http://dx.doi.org/10.1055/s-0038-1626702.

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Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.
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Ravindran, Aju, and Sagesh M. "Effectiveness of oral itraconazole in the management of otomycosis with tympanic membrane perforation." International Journal of Research in Medical Sciences 5, no. 4 (2017): 1373. http://dx.doi.org/10.18203/2320-6012.ijrms20171229.

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Background: Otomycosis can be a difficult problem to treat in a patient who already has a perforation of the tympanic membrane. This study highlights the effectiveness of oral Itraconazole in treating such cases.Methods: Thirty-four patients with otomycosis and a perforated tympanic membrane were included in the study and were treated with oral itraconazole and antibiotic ear drops. They were followed up for six weeks to look for treatment response and any recurrence.Results: Of the 34 patients in the study, 25 patients were fully cured with one week of oral Itraconazole therapy. Six out of the remaining 9 patients were cured of the disease with two weeks’ therapy. Three patients needed prolonged treatment and one patient had a recurrence at six weeks.Conclusions: Oral itraconazole therapy is an effective alternative to the traditional methods of treatment for otomycosis with tympanic membrane perforation.
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Jeer, Mariraj, and N. Mallika. "Clinicomycological Study of Otomycosis." International Journal of Current Microbiology and Applied Sciences 8, no. 04 (2019): 1334–37. http://dx.doi.org/10.20546/ijcmas.2019.804.155.

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Pontes, Zélia Braz Vieira da Silva, Anna Débora Ferreira Silva, Edeltrudes de Oliveira Lima, et al. "Otomycosis: a retrospective study." Brazilian Journal of Otorhinolaryngology 75, no. 3 (2009): 367–70. http://dx.doi.org/10.1590/s1808-86942009000300010.

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Latha, R., R. Sasikala, and N. Muruganandam. "Chronic otomycosis due toMalasseziaSpp." Journal of Global Infectious Diseases 2, no. 2 (2010): 189. http://dx.doi.org/10.4103/0974-777x.62875.

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da Silva Pontes, Zélia Braz Vieira, Anna Débora Ferreira Silva, Edeltrudes de Oliveira Lima, et al. "Otomycosis: a retrospective study." Brazilian Journal of Otorhinolaryngology 75, no. 3 (2009): 367–70. http://dx.doi.org/10.1016/s1808-8694(15)30653-4.

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39

Mugliston, T., and G. O'Donoghue. "Otomycosis—A continuing problem." Journal of Laryngology & Otology 99, no. 4 (1985): 327–33. http://dx.doi.org/10.1017/s002221510009678x.

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AbstractThe microbiology of 12, 174 symptomatic ears presenting over an eingt-year period to one hospital was examined in detail. 1, 061 cases of fungal infection were found. The incidence and pattern of these fungi and the accompanying bacteria, in case of mixed infection, do not appear to have been affected by the widespread use of powerful topically-applied autibiotic/steroid preparations over more than two decades. Otomycosis remains an uncommon, often overlooked but important cause of morbidity in a temperate climate.
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Kaur, Ravinder, Nalini Mittal, Manish Kakkar, Arun Kumar Aggarwal, and Maheshwar Dayal Mathur. "Otomycosis: A Clinicomycologic Study." Ear, Nose & Throat Journal 79, no. 8 (2000): 606–9. http://dx.doi.org/10.1177/014556130007900815.

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Jackman, Alexis, Robert Ward, Max April, and John Bent. "Topical antibiotic induced otomycosis." International Journal of Pediatric Otorhinolaryngology 69, no. 6 (2005): 857–60. http://dx.doi.org/10.1016/j.ijporl.2005.01.022.

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Vennewald, Irina, and Eckart Klemm,. "Otomycosis: Diagnosis and treatment." Clinics in Dermatology 28, no. 2 (2010): 202–11. http://dx.doi.org/10.1016/j.clindermatol.2009.12.003.

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Cojocaru, I., I. Alteraş, and Lucia Dulǎmiǎ. "Some data on the treatment of otomycoses." Mycoses 13, no. 5 (2009): 243–46. http://dx.doi.org/10.1111/j.1439-0507.1970.tb01258.x.

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44

Dorko, E., A. Jenča, M. Orenčák, S. Virágová, and E. Pilipčinec. "Otomycoses of candidal origin in eastern Slovakia." Folia Microbiologica 49, no. 5 (2004): 601–4. http://dx.doi.org/10.1007/bf02931541.

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Koltsidopoulos, Petros, and Charalampos Skoulakis. "Otomycosis With Tympanic Membrane Perforation: A Review of the Literature." Ear, Nose & Throat Journal 99, no. 8 (2019): 518–21. http://dx.doi.org/10.1177/0145561319851499.

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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.
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Villanueva, Joebert M., Marida Arend V. Arugay, and Rachel Zita H. Ramos. "In Vitro Antimycotic Activity of Four Medicinal Plants Versus Clotrimazole in the Treatment of Otomycosis: A Preliminary Study." Philippine Journal of Otolaryngology-Head and Neck Surgery 23, no. 1 (2008): 5–8. http://dx.doi.org/10.32412/pjohns.v23i1.759.

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Objective: To determine the antimycotic activity of the four medicinal plant extracts, kalachuchi bark (Plumeria acuminata Ait.), atsuete bark (Bixa orellana Linn.), akapulko leaves (Cassia alata Linn.), and neem leaves (Azadirachta indica Adr. Juss), when compared to the standard clotrimazole in the treatment of otomycosis.
 
 Study Design: Experimental Study
 
 Methods: Taxonomically identified plants, kalachuchi, atsuete, akapulko, and neem tree were collected and deposited in an herbarium. Extracts of these plants and the standard clotrimazole were tested against isolates of Aspergillus flavus, Aspergillus niger, and Candida albicans taken from patients with otomycosis. Three trials were made for each extract using different solvents and results subjected to statistical analysis.
 
 Result: Of the four medicinal plant extracts studied, only kalachuchi bark extract exhibited antifungal activity against Aspergillus flavus and Aspergillus niger using methylethylketone as solvent when compared to the standard clotrimazole. It was equally effective in inhibiting the growth of A. flavus and A. niger. However, all plant extracts using all types of solvents were equally ineffective in inhibiting the growth of Candida albicans.
 
 Conclusion: This in vitro study suggested that kalachuchi (Plumeria acuminata Linn.) bark extract inhibits the growth of Aspergillus species and was comparable to the standard clotrimazole. Following appropriate further studies and clinical trials, it may be a potential alternative treatment option for otomycosis caused by Aspergillus species.
 
 
 Key words: otomycosis; kalachuchi (Plumeria acuminata Linn.) bark; antimycotic; Aspergillus flavus; Aspergillus niger
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Rutt, Amy L., and Robert T. Sataloff. "Aspergillus Otomycosis in an Immunocompromised Patient." Ear, Nose & Throat Journal 87, no. 11 (2008): 622–23. http://dx.doi.org/10.1177/014556130808701107.

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Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic unilateral otomycosis in a 55-year old, immunocompromised man who had been unresponsive to a variety of treatment regimens. The patient presented with intermittent otalgia and otorrhea and with a perforation of his left tympanic membrane. A niger was identified in a culture specimen obtained from the patient's left ear canal. In immunocompromised patients, it is important that the treatment of otomycosis be prompt and vigorous, to minimize the likelihood of hearing loss and invasive temporal bone infection.
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Aziz, Tabassum, Nousheen Qureshi, Mahwash Khawaja, Rida Ulfat, Tahir Muhammad, and Anum Malik. "Comparison of effectiveness of 7.5% Povidone-iodine with 1% Clotrimazole ear drops and lignocaine in Otomycosis." Journal of Rawalpindi Medical College 24, no. 3 (2020): 193–97. http://dx.doi.org/10.37939/jrmc.v24i3.1161.

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Objectives: Our study is comparing the effectiveness of 7.5% Povidone-iodine with 1% Clotrimazole ear drops and lignocaine in the management of Otomycosis to highlight the importance of replacing conventional antifungals in routine practice.
 Setting: Department of ENT and Head and Neck Surgery, Holy Family Hospital, Rawalpindi, Pakistan.
 Study design: A prospective randomized control trial
 Methodology: This study was conducted for 12 months in our institute from July 2014 to June 2015. A total number of 148 patients with clinically diagnosed Otomycosis between the age group 15 to 55 years were studied. All patients with a clinical diagnosis of Otomycosis presenting with all four features of earache, itching, ear-blockage, and ear discharge in ENT OPD were included. Ear swabs were taken and sent for fungal culture. Patients were divided into A and B groups each comprising of 74 patients. Group A received 1% Clotrimazole ear drops and lignocaine and group B received 7.5% Povidone-iodine for 14 days after the results of cultures were received. At the end of 14 days, patients of both groups were compared based on the resolution of symptoms and signs.
 Results: At the end of 14 days, 32 out of 74 patients (43%) in group A receiving 1% Clotrimazole ear drops and lignocaine reported resolution of all symptoms, and 52 out of 74 patients(70%) showed complete resolution of all signs, while in group B,68 out of 74 patients(91%) showed complete resolution of symptoms and 69 out of 74 patients (93%) showed complete resolution of signs. Our study showed significant improvement in signs and symptoms of Otomycosis achieved by treatment with 7.5% Povidone-iodine compared to that achieved by 1% Clotrimazole ear drops and lignocaine.
 Conclusion: 7.5% Povidone-iodine is a more effective antifungal agent in the treatment of Otomycosis as compared to 1% Clotrimazole ear drops and lignocaine.
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Aboulmakarim, S., H. Tligui, M. El Mrini, I. Zakaria, N. Handour, and A. Agoumi. "Otomycoses : étude clinique et mycologique de 70 cas." Journal de Mycologie Médicale 20, no. 1 (2010): 48–52. http://dx.doi.org/10.1016/j.mycmed.2010.01.002.

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Sumbria, Deepshikha, Aamir Yousuf, and Rauf Ahmad. "Hospital based study on the effect of flood on change in profile of otomycosis in ethnic Kashmiri population." International Journal of Otorhinolaryngology and Head and Neck Surgery 6, no. 4 (2020): 621. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201037.

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<p class="abstract"><strong>Background:</strong> Kashmir valley witnessed devastating floods in the month of September 2014. The target of the study was to assess the changes in clinical profile of otomycosis and fungi responsible for the disease, in-vitro sensitivity of different fungi to various commercially available antimycotic solutions and clinical efficacy of various topical antimycotic solutions in otomycosis in pre and post flood period.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in the Department of ENT, GMC, Srinagar from February 2014 to July 2015. 152 clinically suspected otomycosis patients were subjected to mycological tests to identify the organism. Clotrimazole, terbinafine, lulliconazole, sertaconazole and combination of 1% clotrimazole, chloramphenicol, beclomethasone was given randomly in equal number of these patients and were followed for 4 weeks. Results of different antifungals were evaluated clinically. </p><p class="abstract"><strong>Results:</strong> The trend varies in pre and post flood period. <em>Candida albicans</em> was the most common organism isolated in pre-flood period whereas <em>Aspergillus flavus</em> was the most common organism isolated in post flood period. In the pre flood period <em>Candida</em> and <em>Aspergillus</em> species had equal rate of isolation. However, in post flood period <em>Aspergillus</em> was most common species isolated. Effect of lulliconazole and terbinafine was same in pre and post flood time but serticonazole and fluconazole showed slight variation in effectiveness in post flood period. Clotrimazole and combination of 1% clotrimazole, chloramphenicol and beclomethasone were least effective post flood.</p><p class="abstract"><strong>Conclusions:</strong> Flood had its impact on profile of otomycosis. <em>A. flavus</em> became more common species in post flood period. It was observed that flood had some impact on drug treatment too but further studies and tests are needed to confirm the effectiveness of drugs on treatment of otomycosis.</p>
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