• A high index of suspicion is needed when otitis externa not improving and there are symptoms of significant pruritis. • Signs of fungal debris, either obvious spores or black particles in debris should alert one to take a microbiology swab for fungal culture, which may yield Candida or Aspergillus species. • Treat patients with regular and prompt microsuctioning and application of topical antifungals for up to a month: Aspergillus can be particularly aggressive and lead to tympanic membrane erosions, ulceration and perforation. • Flumetasone/Clioquinol drops are effective in Aspergillus fungal otitis externa • Consider surgical repair if tympanic membrane not healed with medical treatment.