title: Large discrepancies in otomycosis treatment in private ear, nose, and throat clinics in Denmark.
abstract: BACKGROUND
  Otomycosis is a fungal infection of the external ear canal that can involve the middle ear in case of tympanic membrane perforation and also extend to the auricle. Fungi cause 7-15% of external otitis. Diagnosing otomycosis is often based entirely on non-specific clinical signs and symptoms. A multitude of antifungal drugs are available. Some are ototoxic in animals, a few are proven safe, but the ototoxicity of many drugs remains unknown. The aim of this study was to describe how otomycosis was diagnosed and treated by private ear, nose, and throat (ENT) consultants in Denmark and to investigate if the patient's immune status and the presence of a tympanic membrane perforation affected the chosen treatment modality.
  
  
  METHODS
  A questionnaire on the treatment of otomycosis was sent to 147 private ENT consultants.
  
  
  RESULTS
  In total, 103 (70%) responded. 95% performed intensive aural cleaning using an otomicroscope. The initial diagnosis was based on symptoms as only 20% required to see fungal hypha. 42% sent material for culture and sensitivity (C + S) before starting treatment and 92% sent for C + S if treatment failed. 89% used a variety of topical antifungal drugs as the first line of medical treatment. Antiseptics were used in 5%. The presence of a tympanic membrane perforation did not alter the treatment modality. Only 13% treated immunocompromised patients differently.
  
  
  CONCLUSIONS
  The initial diagnosis was based on non-specific symptoms and there were large discrepancies in the chosen antifungal treatment. Topical antifungal drugs were preferred. Additional research is needed.
  
  
  BACKGROUND
  Department of Otorhinolaryngolgy and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark. The Danish Association of Research-interested Otorhinolaryngology Consultants: Kim Werther, Peter Tingsgaard, Mads Stougaard, Steen Telmer, Henrik Møller, Liviu Guldfred.
  
  
  BACKGROUND
  No trial registration was necessary as the questionnaire was anonymous and contained no patient data.
authors.affiliation: elisabetharndal@hotmail.com.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Arndal
authors.forename: Henrik
authors.initials: H
authors.lastname: Glad
authors.forename: Preben
authors.initials: P
authors.lastname: Homøe
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D003718:Denmark; D006801:Humans; D016867:Immunocompromised Host; D000072220:Otolaryngologists; D059249:Otomycosis / Q000175:diagnosis / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D000071836:Professional Practice Gaps; D011795:Surveys and Questionnaires; D018058:Tympanic Membrane Perforation / Q000175:diagnosis / Q000628:therapy
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents