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Having smelly discharge from ear. Prescribed ketoconazole for otomycosis. Is this safe?

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Hello.I'm having transparent smelly discharge from my right ear around half a year. Two weeks ago the XXXXXXX canal got swollen, acute pain started and hearing became worse. I came to a doctor. He washed the ear, retrieved ear wax from it and gave me Aluminium Hydrochloride drops. In two days I came back and he diagnosed Otomycosis. He prescribed Ketoconazole cream.
Before applying the cream I did culture from the ear and got the results: Enterobacter aerogenes. After I started to apply the cream and tea tree and lavender essential oils. During the first week I felt better, but now the pain got back, I still can't hear well. I came to the doctor and he said that it is external otitis. Gave me the same drops for two more days and after these days he said to start to use antibiotic drops - Fosfomycin Sodium.
(usually I dont do any antibiotics and steroids - I use natural stuff for healing everything)

I am living in Bali, Indonesia, and my question is: does it sounds as a propper treatment? The symptoms are the same I still have the pain and can't hear well. And is it possible that this bacteria and fungus can live together at the same time?
thank you
Posted Thu, 11 Apr 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 2 hours later

Thank you for your query.

1. It is common to have infection behind a plug of ear wax.

2. Enterobacter aerogenes is an opportunistic bacteria. Fungal infections frequently have secondary bacterial infections. Bacteria and fungi can easily co-exist. Biofilms in medicine is a new concept.

3. You should consider the fact that the reason for such a prolonged infection may be resistance of the bacteria or fungus.

4. You may get a sensitivity test on the cultures and change the medication accordingly. Alternatively you may first try clotrimazole (Candid) ear drops or Chloramphenicol and clotrimazole (Candibiotic) ear drops if the ear drum is intact.

5. Using creams and essential oils may provide a medium for growth for some organisms. Since they seem ineffective, discontinue them for now. There is also a possibility of sensitivity to the ear drops or their preservatives.

6. Local antibiotics, anti-fungals and steroids are mostly harmless to the body. Your hearing should improve as the infection and edema subsides. Otomycotic debris should be cleaned frequently under a microscope. It speeds up healing.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Above answer was peer-reviewed by
Follow-up: Having smelly discharge from ear. Prescribed ketoconazole for otomycosis. Is this safe? 2 days later
Hello, Dr. XXXXXXX Bhatti.
Thank you for your answer, but steroids are taboo for me. And I can't find the drugs you recommend in Bali. The doctor checked my ear again, washed again, said that there is no traces of fungus, but the external canal is still swollen, and I started to feel the pain in my other ear's external canal. (when I touch my ear with the ear cotton stick I feel the pain, that's why I think it's external canal. There is no "shooting" pain inside both ears) The doctor gave me the Aluminium Hydrochloride drops again to reduce the swell, and after this he said to use Fosfomycin Sodium. Can you explain to me, what exactly the Aluminium Hydrochloride does, and is it enough just to use this one, as I'm not agree to use the antibiotics, because I have an allergy to some antibiotics. I don't know which exactly, but I don't wanna try this on me. Do you have any other suggestions (without any steroids and antibiotics) with some broad spectrum anti-microbal drugs. What it can be?
Thank you very much
Answered by Dr. Sumit Bhatti 6 hours later

Thank you for writing back.

1. It is good to hear that the Otomycosis has cleared. This makes treatment easier.

2. Aluminium Acetate ea drops help in reducing edema (swelling) in the ear canal.

3. If your ear is healing well, you may continue with this treatment.

4. You will require antimicrobials only if the Enterobacter strain is resistant.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

Above answer was peer-reviewed by
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