Results
The incidence ofotomycosisrelates to the injury of EAC10-11,which caused by the use of hard materialsorviolent manipulation to the ears; the cross-infection due to ear cleaning in public places such as barber shops, or swimming in potentially contaminated water, chronic diseases impairing the immunity like diabetes mellitus12and the increase in the use of antibiotics and hormones11、13, in addition, the climate of Hainan island is hot and humid all year round,otomycosis is particularly frequent in this kind of regions14-16.The common strains have been reported in the literatures12、17 that the Candida and Aspergillusspecies were the most common agents,whichare sensitive to antifungal agents.
Pevisone mainly consists of 0.1%triamcinolone acetonide and1% econazole. Triamcinolone acetonide is a medium-effective glucocorticoid hormone, which can improve the anti-allergic, anti-exudation, anti-inflammatory and anti-pruritic effects18. Econazole is a derivative of imidazole which has a broad-spectrum antifungal effect, and is also effective for Gram-positive bacteria19. So as a compound preparation the pevisone has multiple advantages of anti-allergic, anti-inflammatory, anti-pruritic and antifungal effects, meanwhile it’s safe reliable and rapid-onset.
The most widely used treatment regimen for otomycosis includes mechanical debridement of the ear canal along with local antifungal agents,however, there are still problemssuch as recurrence orresidual disease10, and unsatisfactory cure rate,heavy pain during the treating process etc.We found some clinical difficulties in our practice, at first, the remaining mildew moss and purulent secretions couldn’t be cleaned up thoroughly, which may impact the effect of drugs or lead to recurrence. Secondly, when we cleaned the lower anterior part of EAC and the surface of tympanic membrane, it was hard for patients to cooperate with the doctor because of the pain, which led to incomplete cleaning of the lesion. Thirdly, for patients with narrow or over curved EAC, it was difficult to clean up the deep partowing to the limited visual field, especially the lower anterior part, where required the assistance of cotton applicators or alligator forceps for cleaning, which were costly in China. In addition, when we covered the surface of EAC with pevisone by a cotton swab, the head of cotton swab was too large to reach tympanic membrane,and it was impossible to confirm that all the surface of EAC were covered with pevisone.We found that in the literatures there was a lack of specific treatment skill for removing the lesion, and no reference to the difficulty in the treating process and how to relieve pain.
In order to solve the problems above, we improved the procedure during treating process.The cotton balls + the cotton swabtail in the improved method has the following advantages: 1.Soft cotton balls scraping can lower the risk of injuries to tympanic membrane, in contrary, the metal suction device can cause injuries when doing the cleaning work on the tympanic membrane; in addition, cotton balls can relieve the pain in the treating process;2.The suction device can only suck up the lumpy lesions, but the debris or mud-like lesions attached to the surface of EAC can’t be completely removed. The rotation of the cotton ballswhich acts like brushing can thoroughly clean the surface of EAC and absorb away the remaining liquid at the same time;3.The suction device can hardly reach the lower anterior part of EAC where the lesions are usually residual, but the cotton swab tail can easily send the cotton ballthere;4. Compared to the big head of the cotton swabs, the cotton ball is much smaller,which makesthe visual field is clear relatively,sothe EAC can be cleaned thoroughly anddrug can be covered uniformly with the cotton ball; 5.Instead of the costly cotton applicators or alligator forceps, a cheap cotton swab is competent.
In the literatures the frequency and course of treatment for otomycosis are still uncertain.In our study,the treatment frequency was once every other day for three times in total, the treatment course ended within one week, and we choose the 3rd day, the 1stweek, the 1stmonth and 6thmonth of treatment as the observation time points.The cure rates of the improved group(IG)were higher than that in the traditional group(TG) at four observation time points respectively(P<0.05). At 6mo of treatment, the recurrence rate of the IG was lower than that of the TG, the difference was statistically significant (P<0.05), which proved that the cure rate and recurrence rate can be significantly improved with the improved method compared to the traditional method. In addition,we can see the cure number and proportion showed a downward trend from the1st week,that may means the treatment course and frequency need to be further studied.