Fungal Ear Infection: Overview and More

A fungal ear infection, medically referred to as otomycosis, is an infection of the outer ear caused by a fungus. The outer ear is made up of three different parts: the tragus, helix, and lobule (earlobe).

A fungal ear infection can affect all three parts of the ear. It can also affect the ear canal, which connects the outer ear to the eardrum. Fungal infections of the ear canal, however, are by far the most common form of otomycosis.

Fungal ear infections typically occur in one ear at a time. They are thought to affect up to 10% of the population at some point in their lives, and most cases appear in adults in their 30s.

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Fungal Ear Infection Symptoms

Symptoms of a fungal ear infection include:

Itching
Ear pain
Ear discharge that can vary in color (yellow, white, gray, brown, or green)
Hearing loss
Ringing in the ears (tinnitus)

Your ears may also become red, swollen, and inflamed. The skin of your affected ear may also become flaky.

When to See a Healthcare Provider

Fungal ear infections are not likely to go away without treatment. If you experience any symptoms, you should see your healthcare provider as soon as possible.

Causes

The cause of this type of ear infection is a fungus. There are many different genera of fungi that can lead to the condition. The two that most commonly cause fungal ear infections are Candida and Aspergillus.

Candida also causes most cases of yeast infections, while Aspergillus can lead to allergic reactions, lung infections, and infections in other organs.

Risk Factors

Although people come into contact with fungi on a regular—even daily—basis, most do not experience any health issues. Individuals with weakened immune systems, however, may be more susceptible to fungal infections.

Conditions

Having certain health conditions, including the following, may increase the risk of developing a fungal ear infection:

Diabetes
Lymphoma
AIDS
Eczema or other skin conditions

People who have recently undergone a transplant or those who are receiving chemotherapy or radiation therapy may be more susceptible to fungal ear infections, as well.

Other Factors

Research has shown that some lifestyle or geographical factors may also play a role. For example, because fungi thrive in warm and damp places, people living in tropical climates, where humidity is high, are likely to be more at risk.

Other factors that can increase the risk of a fungal ear infection include:

How much wax is in the ear
Ear trauma caused by hearing aids or cotton swabs
Swimming, surfing, or other water sports
Frequent use of medications, such as topical antibiotics or steroids

The Number One Risk Factor for a Fungal Ear Infection

Research has shown that the most common risk factor for fungal ear infections is the habit of cleaning the ears with cotton swabs, wooden sticks, or metal picks.

Diagnosis

To determine if the ear infection is caused by a fungus, your healthcare provider will go over your medical history and any symptoms you have. They will also perform a physical examination using an otoscope, a lighted device used to get a better look inside the ear. They will look for signs of infection in the ear canal and eardrum.

If your ear has fluid, discharge, or any other type of buildup, your practitioner will collect a sample and then send it to a lab. This is done to determine whether the ear infection is bacterial or fungal. Both infections present with similar symptoms, and knowing what is causing the ear infection will make treatment more effective.

Cultures are often not needed because fungal infections have a classic appearance and presentation.

Treatment

There are many different treatment options for fungal ear infections. Treatments will likely differ from patient to patient and depend on the severity of the infection.

Cleaning

The first step in the treatment process is clearing debris out of the ear. There are different tools for this. Some healthcare providers may opt for a rinse, while others may use a suction tool.

Clearing out your ear allows the medication to do its job. Once your practitioner removes the buildup in the ear, they will clean and dry your ear. This helps prevent the overgrowth of fungus from recurring.

Ear Drops

Antifungal ear drops for fungal ear infections are usually clotrimazole. However, other types of medications such as econazole, miconazole, and amphotericin B may be used. Clotrimazole is effective at both curing the infection and preventing it from coming back again.

Topical Medications

If the infection is affecting the inside of the outer ear and the external parts, an antifungal topical ointment can help clear up the fungus and reduce symptoms. Topical medications for these infections include clotrimazole, fluconazole, and ketoconazole.

Research has also shown that solutions with 2% acetic acid plus 90 cubic centimeters (cc) of 70% isopropyl alcohol could effectively treat a fungal ear infection.

Oral Medications

If a fungal ear infection doesn't respond to topical treatments or ear drops, your healthcare provider may prescribe an oral medication, especially if Aspergillus is causing the infection. This type of fungus could be resistant to azole compounds.  

Oral medications will also be the course of treatment if an infection is particularly severe or takes longer than average to heal. Over-the-counter (OTC) medications may help with pain and inflammation.

The course of treatment for a fungal ear infection can last up to four weeks. During this time, the symptoms will continue to improve while the medications work to clear up the infection.

Complications

A fungal ear infection isn't typically a serious condition, but there are some rare cases where it can lead to complications. These complications include:

A ruptured eardrum
Hearing loss
An infection in the temporal bones at the sides and base of the skull
Fungal mastoiditis (inflammation of the bone that is beside the ear)
Inflammation of the brain (encephalitis)

Although these complications are rare, they can be serious or even life-threatening, so it's important to seek treatment promptly if you suspect you have a fungal ear infection.

Prevention

The best ways to prevent the development of the condition are:

Ensuring there is a small amount of wax in the ear to help keep fungus out
Using earplugs when swimming
Drying the ears thoroughly after bathing and swimming with a tissue or by using a hair dryer on a low, cool setting
Being careful not to scratch the skin surrounding the ears or inside the ear
Avoiding the use of cotton swabs in your ears

Coping

Coping with a fungal ear infection can be difficult because of the uncomfortable symptoms. The good news is that if you seek prompt treatment, it's likely that the infection will clear up quickly.

Summary

You are more likely to get a fungal ear infection if you have a compromised immune system or live in a warm and humid climate. Maintaining personal hygiene, keeping your ears dry, and avoiding using cotton swabs to clean your ears are effective ways to prevent this infection.

A Word From Verywell 

A fungal ear infection is rarely a serious condition. It's very treatable and doesn't often lead to complications. It usually requires treatment in the form of over-the-counter medications and prescriptions, so if you suspect you have a fungal ear infection, reach out to your healthcare provider for an evaluation. They can diagnose your condition and help you clean out your ears to start treatment if you do have a fungal ear infection.

This infection isn't always preventable, but there are some steps you can take to reduce your risk of getting it. Keeping cotton swabs away from your ears is one way. Making sure your ears are dry and avoiding overcleaning your ears will help too.

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