Comparison in terms of efficacy between topical clotrimazole and terbinafine for the treatment of fungal otitis externa

Background: Fungal otitis externa (FOE), commonly known as otomycosis, is a fungal infection of the external auditory canal that accounts for a significant proportion of ear infections, especially in warm and humid climates. Aspergillus and Candida species are the most common causative agents. This study aimed to compare the efficacy of topical clotrimazole and terbinafine in the treatment of fungal otitis externa in terms of mycological cure and symptom resolution. Material and Methods: A cross-sectional analytical study was conducted from July 2023 to June 2024 at the ENT Outpatient Department of Bahawal Victoria Hospital, Bahawalpur. A total of 260 patients diagnosed with FOE were randomly assigned to two treatment groups: Group A received clotrimazole 1% solution and Group B received terbinafine 1% cream twice daily for four weeks. Mycological cure and symptom improvement were assessed at week 4. Results: Mycological cure was achieved in 111 (85.4%) of patients in the terbinafine group compared to 91 (70.0%) in the clotrimazole group (p < 0.001). Terbinafine also showed faster symptom relief and fewer adverse effects (2.3% vs. 7.7%). Conclusion: Topical terbinafine demonstrated significantly better mycological and clinical outcomes than clotrimazole in treating fungal otitis externa, with an improved safety profile. Keywords: Aspergillus, Antifungal agents, Clotrimazole, Otitis externa, Terbinafine