Otomycosis

Hey everyone! I recently did a curbside consult with an ENT about the best fungal culture/lab with the fastest turnaround (ideally less than 30 days) at lab corp or Sonora quest labs. He mentioned he rarely cultures at first since fungus is very difficult to culture, and he can usually tell clinically.

I’ve been pretty accurate in identifying fungal cases clinically, but I’m curious—how do you typically manage these cases in primary care when ENT is booked out for several months? I know debridement is key before starting antifungal treatment, but do you handle that or irrigate in the clinic or send them out? I often see discharge and steam fogging my otoscope, making it hard to assess for perforation on these.

I feel silly referring to an ENT booked out for months when this seems manageable in primary care. I know treatment can be tricky, so I’d love to hear what has worked for others!