LONG-TERM FOLLOW-UP OF OTOMYCOSIS AND ITS TREATMENT WITH BIFONAZOLE

Thirty-five patients with symptomatic otomycosis (40 infected ears) co nfirmed by direct microscopy and culture were randomly treated for 1 w eek with either bifonazole 1% cream or solution, and daily mechanical suction aspiration of the debris. An attempt was made to match 10 clin ical parameters with both the mycological and bacteriological findings . There was no significant association between the fungal species cult ured and the clinical parameters did not vary with the presence or abs ence of different bacteria; pus was never present in fungal otitis ext erna. Before therapy, a considerable number of ears had completely ste rile bacterial cultures; after treatment, saprophytic Gram-positive ba cilli, Proteus species and Pseudomonas aeruginosa colonized all the ea rs (P=0.000030). Clinical cure rates 3 days after the end of therapy r anged from 65% to 60% with the cream and solution, respectively. Mycol ogical cure was achieved in 70% of the cream group and in 95% of the s olution treated sites. Two weeks after the end of therapy the clinical cure rate was 72.5% and mycological cure rate 57.5% of the sites. In 17 patients (85%) there was an irritant reaction to the solution, whil st the cream was tolerated well. During long-term follow-up (2.5 years ) 36 sites were examined; 10 ears had otitis externa: in four cases th e infection was due to bacteria, the remaining six were fungal. Four o f the six organisms were different to those isolated at the start of t he study. The relapse rate was significantly associated with predispos ing conditions such as eczema (P=0.0073).