From the Guidelines
Fungal otitis media typically presents with symptoms such as pruritus, pain, hypoacusis, and otic discharge.
Clinical Presentations
- Pruritus
- Pain
- Hypoacusis
- Otic discharge These symptoms are commonly seen in patients with Aspergillus otomycosis, which can involve the middle ear if the tympanic membrane has been perforated 1.
Predisposing Factors
Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis 1.
Complications
If left untreated, Aspergillus otomycosis can extend into the mastoid sinus, creating a chronic fungal mastoiditis 1.
Treatment
Topical therapy using irrigations with acetic acid or boric acid, as well as topical antifungal creams and ointments, may be beneficial in treating fungal otitis media 1. Systemic antifungal therapy, such as itraconazole, voriconazole, or posaconazole, may be necessary in immunocompromised patients 1.
From the Research
Clinical Presentations of Fungal Otitis Media
The clinical presentations of fungal otitis media can vary, but common symptoms include:
- Ear discharge, which was observed in all patients in the study by 2
- Itching, reported by 86.7% of patients in the study by 2
- Pain, experienced by 46.7% of patients in the study by 2
- Decreased hearing, noted in 26.7% of patients in the study by 2
- Blocking sensation, reported by 13.3% of patients in the study by 2
Fungal Etiology
The fungal etiology of otitis media can include various species, such as:
- Aspergillus, which was identified in eight patients in the study by 2 and was the dominant species in the study by 3
- Mucor, seen in three patients in the study by 2
- Candida, which was the causative agent in 35% of patients with fungal external otitis, 80% of those with fungal otitis media, and 5% of patients with inflammation of the postoperative cavity of the middle ear in the study by 4
Diagnosis and Treatment
Diagnosis of fungal otitis media can be confirmed by:
- Histopathological identification of fungal organisms, which provides a quick and fairly reliable diagnosis 2
- Laboratory tests, such as fungal smears, culture, and DNA detection 5
- Imaging examinations, which can help confirm the diagnosis and guide treatment 6 Treatment of fungal otitis media typically involves:
- Antifungal drugs, which can significantly improve the condition 6
- Surgical treatment, such as tympanoplasty, which can help remove the fungal mass and restore hearing 5