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What do you suggest for a perforated ear drum due to a fungal infection?

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ENT Specialist
Practicing since : 2008
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I have a preforated ear drum due to a fungal infection. My ENT told me to stop medicine except for vinegar, because the medicine shouldn't go through the preforation. So, i have had the infection for three weeks now...poor hearing and loud tinnitus. How long will this go on? Any Advice? Is there a chance of permanent damage?
Tue, 8 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Puneet Maheshwari 11 hours later

Thanks for the query.

After going through the description provided by you, I feel you might be suffering from, Otomycosis ( Fungal infection of ear) with CSOM( perforation of ear with discharge).

First of all let me expain you about your disease.

1- What is otomycosis?
Otomycosis is a subacute or chronic superficial fungal infection of the external auditory canal. The fungal agents responsible for this clinical entity are found as saprobes in the environment. The fungi are usually secondary invaders of the tissue rendered susceptible by bacterial infections, physical injury or excessive accumulation of cerumen in the external auditory canal.

2- What is CSOM?
It is chronic suppurative otitis media. It is mostly bacterial in origin. It leads to ear discharge and permanent perforation the ear.

3- Why fungus in the ear?
The ear canal can be easily infected because it is dark and warm, hence bacteria or fungus may grow there, because of high humidity and moisture. This occurs more in those who wear head cover in some part of the world.

Otomycosis most often occurs when too much water gets in the ear canal such as after swimming or showering in chlorinated water. It is also called Swimmers ear or Singapore ear. It is easier for germs and fungus to grow when water removes the protective ear wax. Too much
cleaning your ears can have the same effect.

Now coming to your Questions---

1-How long will this go on?

Well, it takes atleast a week time for decrease in the intensity of symptoms, if you are on right proper treatment.

2-Is there a chance of permanent damage?

Not exactly, complications are rare, there will be no permanent damage, but you will have to follow the proper treatment.

3- Advice--

A)How to prevent Fungus in the ear--

To prevent Otomycosis, it’s important to keep the ear canal’s natural defenses against infection working well. Leave some amount of ear wax in the canal, this has an antifungal property. After swimming or showering, use a towel to dry your ears well. Turn your head to each side and pull the earlobe in different directions to help water run out. A hair dryer set on the lowest speed and heat can also help dry ears, but be sure to hold it several inches from your ear. After swimming in common pool, put few drops of acetic acid ear drops or any other antifungal ear drops. Use ear plugs, when swimming. Custom made ear plugs can be available from a hearing aid shop.

B) Treatment of your condition--

It would be better to see an ENT surgeon. Then he/she will follow these steps for your treatment. Send a swab for microbiological tests to identify the fungal and bacterial pathogens.
1. Your doctor will clean the ear canal by vacuum suction under an operating microscope using normal saline at body temperature. If the ear is painful he might instill little local anesthetic drops before cleaning, to remove all the fungal debris and discharge.
2. He might insert a medicated wick with antifungal and antibiotic cream/ointment.
3. Analgesics will be prescribed for the pain
4. A broad spectrum antibiotic for 5 days would be required.
5. Systemic antifungal therapy like ketaconazole, Iconazole rarely.
6. After you will get relief from otomycosis, then your doctor may plan for tympanoplasty, to close your ear perforation.

Hope this answers your query. In case of any doubts, I am available for the follow ups.
Above answer was peer-reviewed by
Follow-up: What do you suggest for a perforated ear drum due to a fungal infection? 3 hours later

Thank you so much!! You gave a very detailed and reassuring response. It's unfortunate my own ENT can't answer as well as you. So, as long as I get one follow-up question.......when I put my ear drops in, some of the fluid immediately goes down my throat. Is this due to the punctured ear drum, or is it a normal response.
Thanks again!!!
Answered by Dr. Puneet Maheshwari 22 minutes later
Hi, its my pleasure to solve your query,

Actually, there is a tube called as pharyngo tympanic tube or eustachian tube that connects the throat with ear. normally, in case of patent ear drum, the fluid doesn't pass from ear to throat,

But, in your case that is the perforated ear drum, the ear-drops, which is bitter in taste, passes from the middle ear to throat via this ET tube.

It is a normal phenomenon, don't worry for this condition,, please just follow the above instructions, you will surely be all rite.


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