Erciyes T1p Dergisi 14: 2; -30, 1992
TREATMENT OF OTOMYCOSIS WITH ACETIC ACID AND BORIC ACID OTOMIKOZUN ASETIK AS IT VE BORIK ASITLE TEDAVIS I Mustafa Erkan*, Tahsln Asian*, Omit Soyuer**
Ozet: Otomikoz olarak te~his edilen 61 hasta, Summary: Sixty one patients with an initial gun a~1n kulak aspirasyonu ve iki antiseptik diagnosis of otomycosis were treated every ajandan biri (Asetik asit ve Borik asit) other day with aural suction and a choice of kullan1larak uc; hafta ic;inde tedavi edildi. two antiseptic preparations (Acetic acid and Hastalar remisyon saglan~ncaya kadar gun Boric acid) for three weeks. The patients were a~m kontrol edildi ve degerlendirildi. Bu assessed every other day until a remission c;a11~ma ile d1~ kulak yolundaki fungal was established. The result of this study enfeksiyonlann primer antifungal showed that it is possible to treat fungal kullanmakSIZin s1k aspirasyon, asetik asit ve infections of external ear canal using frequent borik asit kullanarak tedavi etmenin mumkun aural toilet and installation of asetic and boric oldugu sonucuna vanld1. acid without antifungal treatment.
Anahtar kellmeler: Otomlkoz, asetik aslt, Key words: Otomycosis, acetic acid, boric borik asit. acid.
Otomycosis is not a life-threatening ailment no preparation has become widely accepted, but can be a very frustrating disease for and little is known about the safety of most patient and physician. It represents almost antimycotics (5). Several clinical anecdotes exclusively an infestation of the external and studies report on the efficacy of a wide auditory meatus. If the ear-drum is not intact, range of topical agents for otomycosis ( 1). e.g. in chronic otitis media, the middle ear may be involved in the disease process. The aim of this study is to find out the efficacy Treatment of otomycosis involves careful and safety of acetic acid and boric acid as a cleaning of the external auditory canal under antiseptic agent in treatment of otomycosis the operating microscope. Although this is without using antimycotic preparations. sufficient in some cases, most clinicians agree that topical therapy is a useful adjunct to shorten the course of the disease (6) but
Departments of ENT* and Dermatology**. Faculty of Medicine, Erciyes University, 38039-Kayseri, Turkey. Treatment of Otomycosis With Acetic Acid and Boric Acid: ERKAN Mustafa ve ark.
MATERIAL AND METHOD Similarly, a grade of 0-111 was given for each of the signs erythema, swelling, debris, and Sixty one patients diagnosed otomycosis in mycelial mat. Value of each signs are as another study (2) were recruited for this follows: Erythema 1, Swelling 2, Debris 3, study. Patients with otomycosis were Mycelial mat 3 points. scheduled randomly as two groups (31 patients in first group and 30 patients in This gave figures which were combined to second group). Pre and posttherapic give a score for the severity of the otitis audiometry was performed to all patients. externa. Normal (0): 0 , Mild (I): 1-5 , Patients in the first group were treated with Moderate (II): 6-12, Severe (Ill): 13-17. acetic acid (2%) with hydrocortisone (Drop A) and patients in the second group were treated All patients were asked for their comments on with boric acid saturated in alcohol (Drop B). the medication, and in particular if it were uncomfortable due to stinging. The composition of the drops was as follows: RESULTS Drop A Constituents Acetic acid 2% All patients were cured within 3 weeks of Hydrocortisone 1 % starting treatment. Four of the patients in Sterile water to 1 00% group A and 22 of the patients in group B complained of the drops stung but any patient did not refuse the treatment. None returned Drop B Constituents with recurrence within 6 months. Boric acid 4% Table I shows the number of patients who Absolute alcohol 25% had been cured in each group at their weekly Sterile water to 100% visit. Table II shows the severity of otitis externa in Each patients underwent aural suction toilet our patients at presentation. under an operating microscope on Usually discharge, tinnitus and pain were presentation and every other day, thereafter improved respectively at the begining of until there were no signs of otitis externa treatment in both groups. Sensation of present. The patients were instructed to put fulness and itching were improved later. We four drops in the affected ear(s) two times observed decreasing the mycelial mat and daily and continue for four weeks. Strict swelling first and, debris and erythema later in instructions were given to avoid any every other day control of patients. The scratching or manipulation of the ears. At the patients with low scores were treated usually every visits the patient was asked to grade in one week, and the patients with high each of the symptoms itching, pain, fullness scores were treated in two or three weeks. of external ear canal, tinnitus, and discharge We established that pre and posttherapic on a scale of 0-111. Value of the each audiometries were normal in all patients. symptoms are as follows: Itching 1, Pain 1, Fu llness of external ear canal 2, Tinnitus 1, DISCUSSION Discharge 3 points. Successful treatment of otomycosis depends
Erciyes T1p Dergisi/1411992 28 Treatment of Otomycosis With Acetic Acid and Boric Acid: ERKAN Mustafa ve ark.
Table I. No. of patients cured each week
Treatment No. of Group Patients Week 1 Week2 Week3 Week4 No. (%) No. (%) No. (%) No. (%)
A 31 18 (29.5) 10 (16.4) 3 (4.9) B 30 13 (21.3) 15 (24.6) 2 (3.2)
Total 61 31 (50.8) 25 (41.0) 5 (8.2)
Table II. Scale of patients at presentation
Scale No. of patients Average of Score Range
Normal (0) 0 Mild (I) 22 3.7 1-5 Moderate (II) 30 9.6 6-12 Severe (Ill) 9 14.6 13-17
Total 61
on the physician's diligence in properly addition to topical therapy and strict cleaning the affected ear canal. We believe precautions to prevent water from entering that this is best done under magnification the ear (5). (With the operating microscope). Otten, removing the fungal mat results in a bleeding Than et al in Burma showed that topical 5-FC red epithelium that is exquisitely tender. The applied once a week to the external ear canal patient must understand that severc:i visits for had a 100% cure rate. Nystatin ointment was vigorous aqd thorough cleaning may be second best. Than suggest that boric acid necessary at two or three day intervals, in powder is a good alternative in parts of the
Erciyes T1p Dergisi/1411992 29 Treatment of Otomycosis With Acetic Acid and Boric Acid: ERKAN Mustafa ve ark.
world where other agents are not available or References too costly (7). Erkan et al found that topical application of acetic acid 12 %) + 1. Conley, J: Evaluation of fungous disease hydrocortisone combinations twice a day for of the externai auditory canal. Arch three weeks were very effective (3) . Otolaryngol 47:721-745,1948. 2. Erkan M, Soyuer 0: Otomycosis in Kayseri Marsh and Tom assessed the ototoxicity of (Turkey). Revista lberoamerlcana de
The main conclusions that can be drawn from this study are that every other day aural toilet and a topical agent is good treatment fo r otomycosis. Boric acid and acetic acid, combined with frequent aural toilet should be used as a first line medication because of their antiseptic properties. This will avoid the objections of allergic reactions to antimycotics, and resistance development.
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