Can athlete's foot grow in the ears?

Author: Li Zhuo Department of Otolaryngology, Beijing First Hospital of Integrated Traditional Chinese and Western Medicine

Reviewer: Li Hongbin, Associate Chief Physician, Department of Otolaryngology and Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University

Athlete's foot is a fungal infection of the pedis, which often causes blisters and scaling between the toes, heels, soles, etc., accompanied by a certain degree of itching. Athlete's foot is a fungal infection of the superficial skin of the feet caused mainly by dermatophytes such as Trichophyton rubrum and Trichophyton mentagrophytes.

In addition to fungal infections occurring on the feet, frequent ear picking or going to an ear cleaning parlor for "ear cleaning" can also easily lead to fungal infections in the ear canal, causing the ear canal to become moldy and grow hair. This is external auditory canal fungal disease, a common disease in ENT clinics. It is caused by fungal infection of the external auditory canal, with Aspergillus and Candida being the most common pathogens of the infection.

The two diseases infect different types of fungi, but they are both fungal infections, which leads many people to believe that it is "athlete's foot growing in the ears."

1. Misunderstandings about ear canal diseases

1. Thinking that earache and itching are minor problems that do not require treatment.

Some people think that this "minor illness" is just "getting angry" and that it can be cured by taking some "anti-anger medicine". In fact, the longer the illness is delayed, the more difficult it is to treat, and it is not uncommon for it to affect work and life.

2. Thinking that ear pain and itching are simply inflammation and can be cured with a few drops of medicine.

Some people think that ear pain and itching are caused by inflammation and can be cured by putting some ear drops. Common ear drops on the market include antibiotics, hormones, hydrogen peroxide (hydrogen peroxide), etc. However, few people know that these ear drops may cause fungi to reproduce more rapidly, thereby aggravating the condition.

2. Causes of fungal infection

1. Narrow ear canal

The ear canal is too narrow, which is the most basic anatomical factor for the onset of fungal disease in the ear canal. The normal external auditory canal has two physiological curves, which are S-shaped. For some people, the curvature is too large, which can easily cause prolonged fungal infection.

2. Ear cleaning

Many people often carry a small ear pick on their keychains. They are used to using the ear pick to pick their ears when they are free, or to go to informal medical institutions for ear cleaning to relieve stress. In fact, this is the most common way of fungal infection. Many informal ear picking and ear cleaning can lead to fungal infection. If the external auditory canal is damaged at the same time, the outflowing fluid or blood will create convenient conditions for the growth and reproduction of fungi, and fungal spores and hyphae can also grow and reproduce rapidly. Although ear picking can relieve symptoms such as ear stuffiness and itching, it can also cause worse damage to the eardrum and external auditory canal, forming a vicious cycle, aggravating inflammation, and may lead to a series of serious consequences, such as hearing loss and eardrum perforation.

Figure 1 Copyright image, no permission to reprint

3. Frequent wearing of headphones

As urban commuting time increases, people spend more and more time wearing headphones to listen to music, news, and learn English. Some people even wear headphones when they sleep, which is also the main cause of external auditory canal fungal disease.

4. Humidity

Being in a humid and warm environment for a long time, such as the summer in the north, the rainy season in the south, tropical or subtropical humid areas, frequent swimming or bathing, etc., will cause the external auditory canal to be in a humid environment. The normal external auditory canal is in an acidic environment, and the pH value of the ear canal changes after water enters and becomes moist. Once this acidic environment is destroyed, it is very easy to cause fungal growth.

5. Irregular use of medication

Fungal infection of the external auditory canal is sometimes easily confused with acute bacterial otitis externa, which causes some patients to use antibiotic ear drops for a long time, or to use excessive amounts of hormone-containing ear drops to repeatedly flush the ear canal, resulting in persistent symptoms and seriously affecting the patient's quality of life. These improper treatments will change the internal environment of the external auditory canal, not only providing an opportunity for fungi to take advantage, but also providing them with a favorable growth environment.

6. Otitis media or after otitis media surgery

Patients with otitis media or long-term pus discharge after otitis media surgery, whose symptoms are ineffective or worsen after conventional treatment, are likely to have fungal infection and need to go to the hospital for secretion testing in time to receive timely and correct treatment.

7. Systemic chronic inflammatory and immunocompromising diseases

People with diabetes who have poor blood sugar control and those with immune deficiencies are also prone to fungal infections.

3. Symptoms and characteristics

Mild symptoms : itching, discharge and pain in the ear.

More serious : hearing loss, tinnitus, tympanic membrane perforation, intracranial infection.

Manifestations during examination : Obvious gray, white, black, or yellow fungal masses and spores, or powdery, granular, villous, or lumpy fungal spots in the external auditory canal.

Figure 2 Copyright image, no permission to reprint

IV. Treatment

The keys to treating this disease are: early diagnosis, use of sterile instruments, thorough and timely cleaning, local antifungal treatment, adequate course of treatment, and keeping the ear canal dry.

1. Diagnose as early as possible

Secretion culture is the gold standard for confirming fungal infection. Patients suspected of having fungal infection should undergo fungal microscopy or fungal culture as soon as possible, which can provide an early diagnosis and targeted treatment. Ear canal secretion culture is a routine examination for ear canal diseases. It can also detect the specific type of infected fungi and help screen effective antifungal drugs.

2. Use sterile instruments

It is necessary to use instruments that have been sterilized in accordance with the strict requirements of regular hospitals to ensure that each person is disinfected, or use disposable instruments for ear examination and treatment.

3. Thorough Cleaning

Since most ear canal fungi originate from the surface of the eardrum or the angle formed by the eardrum and the external auditory canal, the above two parts cannot be reached in informal hospitals or ear cleaning parlors. You need to go to the hospital and use an ear endoscope to clean from the ear canal opening to the surface of the eardrum, and thoroughly clean all suspicious hyphae, lumps and scabs. Guided by the ear endoscope, the field of vision is very clear and will not damage the ear canal skin and eardrum. You can also understand the swelling, congestion and ulcers of the ear canal and the condition of the eardrum in detail, which is important for judging the severity of the disease, whether there are allergic reactions, and whether there are bacterial infections. When applying the medicine locally, the effect of the medicine can also be fully exerted, creating good conditions for improving the clinical cure rate.

4. Clean up in time

During the local application of medication, hyphae and scabs may grow at the same time. Therefore, it is necessary to clear the ear canal secretions before applying the medication. That is, after most of the fungal hyphae and spores are cleared, the medicine can fully contact the eroded skin. This can not only relieve the patient's ear pain, ear stuffiness and other discomfort symptoms as soon as possible, but also improve the efficacy and shorten the course of the disease.

5. Topical antifungal

Fungal infection of the external ear canal is a superficial fungal infection that mainly invades the stratum corneum of the skin. Oral antifungal drugs such as nystatin and amphotericin have many systemic adverse reactions. Therefore, oral antifungal drugs are generally not considered in treatment, but appropriate topical antifungal drugs such as pevisone, dacronil, ketoconazole, bifonazole, etc. are selected.

6. Sufficient treatment course

Fungal infections of the external ear canal are often found deep in the narrow ear canal, where the ventilation effect is very poor and the fungus itself is very stubborn. Once you get the disease, it is difficult to cure and it often recurs. Many people stop taking the medicine immediately after the symptoms are slightly relieved after 3-4 days of local medication. However, symptoms such as stuffy ears, itchy ears, ear pain and pus discharge recur again in about a week. Therefore, a full course of medication can completely cure the disease and avoid recurrence.

7. Keep it dry

Fungi can easily grow and reproduce in a humid environment, so it is particularly important to keep the ear canal dry and clean. If water enters the ear canal after swimming or bathing, you can gently wipe it dry with a disposable dry cotton swab, or use a hair dryer with a low air volume (the air volume should not be too large, and the time should not be too long).

5. Prevention

Do not wear headphones frequently; do not pick your ears frequently or do not clean your ears in an unclean way; do not use ear drops at will; if water enters the ear canal, treat it as soon as possible to keep the ear canal dry; maintain a good attitude and avoid tension and anxiety; maintain a normal life and work schedule and avoid staying up late; abstain from smoking and drinking, and avoid eating spicy and irritating foods.