Effectiveness of 7.5 percent povidone iodine in comparison to 1percent clotrimazole in the treatment of otomycosis.

Ajay, Philip (2012) Effectiveness of 7.5 percent povidone iodine in comparison to 1percent clotrimazole in the treatment of otomycosis. Masters thesis, Christian Medical College, Vellore.

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Abstract

Objectives This was a prospective randomized case control study and its objective was to establish the effectiveness of povidone iodine in treatment of otomycosis to a commonly used antifungal, clotrimazole. Our secondary objective was to identify the most common fungal isolate in our hospital. The two drugs were compared on the improvement in symptoms and signs of the affected individuals. Review of literature Otomycosis or fungal otitis externa is a condition seen in any otolaryngology set up and can be quite frustrating for the patient and the doctor due to its recurring nature. It is a superficial, sub-acute or chronic infection of the outer ear canal, usually unilateral characterized by inflammation, pruritus, pain and scaling (1). Prevalence is more in the tropical and subtropical humid climates(4). Candida and aspergillus are the most common fungi isolated (2). The most common aspergillus isolate was the niger species (3)(4) followed by the species of flavus and fumigatus. Treatment mainly comprises of thorough lavage of the ear and clearing all fungi debris mainly seated in the anterior recesses of the ear canal (5). Predisposing factors must be addressed and topical antifungals initiated. Clotrimazole is the most commonly used antifungal. This drug acts on the fungal wall making them to be more permeable and lead to their instability and later cell death(6). Povidone iodine, is a widely used antiseptic, easily available, cheap and seen to be effective in the treatment of bacteria, fungi, virus, protozoa and spores (7). No resistance is known so far to this antiseptic (8). Hence we planned to use povidone iodine in this study in view of its above properties. Methodology We conducted a prospective randomized case control study of individuals who were clinically diagnosed with otomycosis in our ENT OPD. The individuals who satisfied the inclusion criteria were randomized and blinded to the drug they would receive. The symptoms and signs were noted and a pretreatment ear swab was taken for culture. On follow up after 2 weeks, their symptoms, signs were noted and a post treatment ear swab taken. Each of the pretreatment and post treatment variables were compared and efficacy of the drug assessed. Results and Conclusion 34 patients, clinically diagnosed as otomycosis who fulfilled the inclusion criteria were assessed, 8 were lost to follow up. In our study, the condition was more prevalent in females below the 30 age group. Unemployed individuals topped the list followed by housewives. The left ear was most commonly affected involving 74 % of the cases. Pruritus was seen in 76.5% of our patients followed by otorrhoea. There was a close relation between self-cleaning and absence of wax. Mixed infection was more common (35.4%) and aspergillus niger formed 60.86% of fungal isolate. Pseudomonas aeruginosa and non-fermenting GNB was the most common bacterial isolate. Both drugs showed a good response in symptoms and signs after treatment and though comparable, were not statistically significant(p value>0.05). The result of this study supports the use of Povidone-iodine in the treatment of otomycosis, thus avoiding emergence of resistant organisms. Future studies in larger groups of patients are necessary to see which is more effective. This study has opened a window in the application of povidone –iodine in clinically diagnosed case of otomycosis in humans in addition to the management of chronic suppurative otitis media.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Otomycosis; fungal otitis externa; fungi; antifungals; clotrimazole; povidone-iodine; aspergillus; candida
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 12 Jul 2017 10:41
Last Modified: 12 Jul 2017 10:41
URI: http://repository-tnmgrmu.ac.in/id/eprint/1541

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