Otomycosis: a neglected disease.

A SURVEY of British literature leaves the impression that otomycosis has never held a prominent place among ear diseases in this country. Dismissing the condition in a few lines, most authors suggest that it occurs infrequently and that treatment is a simple matter of applying some wellknown preparation. It is, however, apparent in most clinics that the discharging ear still presents unsolved problems. There is that small nucleus of patients who come and come again; whose treatment theme has infinite variations with but one tangible result—a steady increase in the thickness of their outpatient notes. With these thoughts in mind the present writers decided, some four years ago, to investigate patients of this type for the presence of an active fungus infection. There were several good reasons for this. Local antibiotic therapy, while not in universal use, had attained significant proportions in the treatment of both external and middle-ear infections, and it has been recognized that jintibiotic therajjy elsewhere could lead to secondary infection by fungi. The very sparsity of British papers on the subject suggested that there might be much to learn about the role of the fungi in ear infections. Perhaps the most significant feature of the present series was the jaossibility of controlling clinical diagnosis by the investigations of a trained mycologist, and there were few examples of this having been done before. From the start it was agreed that a diagnosis of otomycosis would be made only in those cases where a fungus was seen to be growing actively in a sample of debris taken from the external auditory meatus. Since fungus spores abound in the atmosphere, and might well enter the meatus only to lie dormant there, their detection by the culture of a swab taken from the meatus could not be regarded as evidence that they were playing an active part in an infective process therein. Where it appeared that the fungus was, in fact, playing an active part in infection it was planned to give treatment aimed specifically at eliminating it. Resolution of the clinical condition might then be accepted as reasonable proof that the fungus had caused it, or was a contributing factor in its maintenance. It was, of course, understood that this proof did not necessarily satisfy Koch's postulates. No attempt to transfer the infection to animal