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.