|Year : 2013 | Volume
| Issue : 1 | Page : 18-19
Medicated gelfoam for the treatment of recalcitrant otomycosis
Surya Prakash Dorasala, Srinivas Dorasala
Department of ENT, MS Ramaiah Medical College and Hospitals, Bangalore, Karnataka, India
|Date of Web Publication||6-Mar-2013|
Surya Prakash Dorasala
Department of ENT, MS Ramaiah Medical College and Hospital, MSR Nagar, MSRIT Post, Bangalore - 560 054, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Otomycosis is a very common condition accounting to almost 20% of all outpatient ENT consultations. Treatment of otomycosis is very simple. However, sometimes, it is very difficult to treat, especially in patients with chronic suppurative otitis media and immunocompromised states. We describe a technique, which we have been using regularly for the past two years in patients with recurrent and persistent otomycosis, which has been very effective in the management. Materials and Methods: Six patients presenting with recalcitrant otomycosis not responding to conventional management were treated with medicated gelfoam placed in the external auditory canal. Results: All patients showed complete resolution of otomycosis and tolerated the treatment. Conclusion: Use of antibiotic antifungal using gelfoam as a carrier is an effective and well tolerated method for treating recalcitrant otomycosis.
Keywords: Gelfoam, Otomycosis, Topical ear drops
|How to cite this article:|
Dorasala SP, Dorasala S. Medicated gelfoam for the treatment of recalcitrant otomycosis. Indian J Otol 2013;19:18-9
| Introduction|| |
Otomycosis, an infection caused by fungus in external ear, is a very common occurrence in ENT practice. Most patients present with a blocked sensation in the ear or aural fullness. Some patients present with severe pain when the fungus has caused significant excoriation of the superficial skin. Most of the patients are relieved by gentle suction clearance and application of topical antifungals. However, there is a subgroup of patients who cannot tolerate the ototopicals. They get intense pain on application of ear drops. Patients with chronic suppurative otitis media get intense irritation on application of ear drops due to middle ear irritation. There is another group of patients who come back even on continuing to use ear drops with persistent otomycosis even after regular suction clearance. They sometimes have confounding skin conditions like atopy, seborrheic dermatitis, psoriasis, etc. Fungal cultures are positive only for the routine fungi. There is no mucor. It is in these situations where we need to think of the next line of solution for the management. We describe a technique in which the absorbable gelatin sponge is used for the treatment of recurrent and persistent otomycosis.
The ear canal is completely cleaned of all the fungal debris by microsuctioning. Gelfoam (absorbable gelatin sponge), which is routinely used for tympanoplasty, is taken. It is prepared in the same way it is done for tympanoplasty surgery. The pressed and cut gelfoam pieces are soaked in the topical antifungal and antibiotic ear drops. Using a microcup/alligator forceps, the gelfoam pieces are placed in the external auditory canal from deeper to outer, layer by layer, completely filling the canal. Patient is advised to instill ear drops over the gelfoam for three days. At follow-up at three days, the gel foam pieces are suctioned out.
| Discussion|| |
The most important reason for persistent and recurrent otomycosis is inability to use ototopical antifungals and persistent moisture in the external auditory canal. Gelfoam acts as a very good dessicant by absorbing the water and reducing the moisture in the external auditory canal. It holds the antifungals instilled and swells up, thus maintaining contact with the external auditory canal skin for prolonged time in good concentrations and also facilitating slow release, which is very important for cidal activity on the fungi.  This in turn prevents the stinging and burning sensation associated with ear drops and helps achieve patient compliance.  Also, gelfoam by itself acts as a very good antibacterial agent.  Till date, we have treated six patients [Table 1] of recalcitrant otomycosis using this technique. There has been complete cure with no further recurrence of otomycosis. Though it is possible that this technique is already being used by other ENT surgeons, we have not come across this technique in published literature. Therefore, we found it appropriate to make this technique known in the published literature for the benefit of ENT fraternity.
| References|| |
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