Background <p>Otomycosis is a medical condition defined as the epithelial infection of the external auditory canal caused by yeast cells and filamentous fungi, and constitutes about 9% of external otitis. The purpose of this research was to critically compare the outcomes of topical application of silver nitrate gel 0.2% versus clotrimazole cream 1% in the management of otomycosis and in decreasing the recurrence rate.</p> Methods <p>This prospective comparative study included 200 adult patients with otomycosis attending the Outpatient Clinic of the Otorhinolaryngology Department at Benha University Hospitals. The cases were assigned to 2 equal groups: group (1) managed with silver nitrate 0.2% gel-soaked Gelfoam, and group (2) managed with clotrimazole 1% cream-soaked gauze. Patients were examined with an otoscope.</p> Results <p>Group (1) had significantly lower edema at 3 days than group (2) (<i>P</i> = 0.018), with no significant difference between both groups at 1&#xa0;day, and both had no edema at 1 week. At 3 days and 1 week, group (1) had significantly lower pain than group (2) (<i>P</i> = 0.026, 0.043), with no significant difference between the two groups at 1&#xa0;day. Group (1) exhibited a significantly earlier resolving time and also a reduced recurrence rate than group (2) (<i>P</i> &lt; 0.001, <i>P</i> &lt; 0.001).</p> Conclusions <p>In the treatment of otomycosis, both clotrimazole 1% cream and silver nitrate gel were effective. Silver nitrate gel was superior to clotrimazole, with earlier resolution and fewer/minimal recurrences.</p>