Review of Recurrent Otomycosis and Clotrimazole in Its Treatment

Otomycosis is a disease whose acute form affects four in 1,000 persons annually and the chronic form affects 3-5% of the population. It is brought on by various fungi, primarily saprophytes which most commonly include the Candida albicans and Aspergillus niger. The disease rarely poses a life-threatening danger, but as it requires prolonged treatment and follow-up and has a significant chance of recurrence, it has a difficult and taxing course. Numerous therapeutic modalities are available for the treatment of otomycosis. In the beginning, the fungal elements are removed by ear toilet - washing or suctioning of the ear canal followed by drying. Topical therapy includes the use of antifungals, of which the most commonly used drugs include clotrimazole or miconazole, often given along with ceftazidime which is an antibacterial. The primary mechanism by which clotrimazole works is by impairing the permeability barrier of the cytoplasmic membrane of the fungi, which causes holes to appear in the cell membrane and leaking out of the contents of the organism, thus killing the fungus and treating the infection. Various studies suggest that following clotrimazole drop therapy, symptoms suggestive of otomycosis are not at risk for recurrence of the disease and due to its economical pricing and easy availability, is frequently recommended by otolaryngologists in the treatment of otomycosis. In this review article, we will discuss about the effectiveness of the drug in different populations, observe treatment failures and relapse of the disease, analyze the ability of clotrimazole drops in preventing relapse of the infection, and observe the role of the drug in reducing the signs and symptoms of the disease.