Otomycosis with pus. (Otoscopic Clinic).

This otoscopic view of a right ear shows a dry, 20% central perforation of the pars tensa and extensive acute otitis externa with fronds of both white and black fungi. The floor of the external auditory canal is covered with thick, cream-colored pus. Otomycosis is a result of a secondary invasion of the ear canal and, when a perforation is present, an invasion of the middle ear when conditions are right. Fungi are not the primary problem and are usually easily eradicated. Treatment involves profuse and frequent irrigation of the ear with vinegar. Fungi cannot survive in an acid environment. Occasionally, antifungal or cresyl acetate eardrops are useful. After the ear has become dry, surgical repair of the perforation and education of the patient in the proper toilette of the ear canal to keep it dry (e.g., the use of rubbing alcohol after swimming) is usually successful in preventing recurrences.

From Gap, France (Dr. Deguine), and the Pulec Ear Clinic, Los Angeles (Dr. Pulec).