Modern Approaches to the Treatment of Otomycosis in Children: Antifungal Therapy, Ozone Therapy and Immunocorrection (Literature Review)

The review analyses clinical studies and meta-analyses on the efficacy and safety of otomycosis treatments, together with the pathogenetic rationale for ozone therapy and immunocorrection. Topical azoles (clotrimazole, miconazole, sertaconazole, luliconazole) combined with meticulous aural toilet are first-line therapy; antiseptic solutions are an inexpensive alternative but require caution in tympanic membrane perforation because of ototoxicity. Recurrence after conventional treatment reaches 15–30%, which drives the search for new approaches. Besides a direct fungicidal effect through oxidation of the fungal cell wall and membrane, medical ozone has antihypoxic, regenerative and immunomodulatory properties, and ozonated oils have proven effective in skin and nail mycoses. Antifungal defence relies on the Th17/IL-17 axis, natural killer cells and IL-10-mediated regulatory mechanisms, and their disturbance leads to chronic and recurrent disease. Combining topical antifungal therapy with ozone therapy and immunocorrection is a promising direction for treating otomycosis in children.