Do not forget about fungal otitis externa (otomycosis)!

This is rare but it will present itself at some point in your career. I think I have seen 2 cases in 8 years of working urgent care.

The presentation is similar to bacterial otitis externa. The patient will complain of ear pain, hearing loss and drainage.

Exam of the ear canal will reveal grayish white thick debris and white/grey/black spots and/or flat lesions.

Treatment is straight forward. The ear must be cleansed to remove the fungal debris and elements. A topical anti-fungal agent should also be prescribed. The first line option is clotrimazole 1% solution applied twice daily for 10-14 days.

Be on the lookout for otomycosis. You will see this presentation at some point in your career!