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, in a fungal ear infection the ear may start to itch and become uncomfortable. You may notice discharge leaking out of the ear.

The itching is often worse with fungal infections than with other types of ear infection. Apart from this the symptoms of a fungal ear infection are often identical to ear infections caused by germs (bacteria). This means your doctor may prescribe antibiotic ear drops to start with and may only suspect a fungal infection when the treatment doesn't work.

Who gets a fungal ear infection?

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

How do you get a fungal ear infection?

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 wool swabs) 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.

How is a fungal ear infection diagnosed?

It you've just come back from SCUBA diving in Hawaii, your doctor may well suspect a fungal cause for your ear infection. They may also suspect it from what they see when they examine you, or if you have a reason to be more prone to fungal infections because your immune system isn't working properly. Otherwise, because a fungal infection can look like an infection from germs (bacteria), it's unlikely to be the first thing your doctor thinks of. Most likely, a fungal infection will only be suspected if your infection does not improve with antibiotic drops prescribed for a bacterial infection.

Will I need any tests for a fungal ear infection?

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 the doctor (or nurse) putting a swab that looks very similar to a cotton bud in your ear and swishing 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.

Is a fungal ear infection dangerous?

Fungal ear infections usually cause a fair amount of discomfort and discharge so most people want to see a doctor soon after the condition starts. There are some eardrops available 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.

How do you treat a fungal ear infection?

Aural toilet

If the inside of your ear looks really messy, the doctor may suggest a clean-up. 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.

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.
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. There's no real evidence that one is better than another.

Further treatments

If you've tried antifungal drops for a couple of weeks and you're still having problems, stop the treatment and go back and see your doctor. You may need further investigation and/or referral to a specialist. Hospital doctors have special ways of getting 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).

What is the outlook for a fungal ear infection?

Providing you're otherwise fit and well and do not have a weakened immune system, the infection should respond fairly quickly to antifungal medication. 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 become persistent. Also if you're exposed to whatever it was that caused the infection in the first place (for example, you go straight back to water sports again), it's likely to return.

The problem with fungal ear infections (and other types of otitis externa) is that once the ear canal is infected the defence system protecting the ear may not return to normal and a vicious cycle is set up, which could cause hearing loss. This explains why frequently poking around inside your ear with a cotton bud (some people call it 'cleaning the ear') prolongs the condition.