From the Guidelines
Clinical Presentations of Fungal Acute Otitis Externa
Fungal Acute Otitis Externa, also known as fungal otitis externa or otomycosis, is an infection of the outer ear canal caused by fungal pathogens, typically Aspergillus or Candida. The clinical presentations of this condition include:
- Itching, redness, swelling, and discharge in the ear canal, which can be severe and debilitating
- Otalgia (ear pain), which can be severe and radiate to the temporomandibular joint or face
- Temporary hearing loss or a sensation of fullness in the ear due to the blockage of the ear canal by fungal debris or inflammation
- Inflammation and potential spread to surrounding tissues if left untreated
Special Considerations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal has been described 1. In these cases, systemic antifungal therapy appears necessary. However, infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal and topical therapeutic options.
Potential Pitfalls and Decision Forks
- In some cases, Fungal Acute Otitis Externa can be a complication of bacterial otitis externa or other conditions that compromise the ear canal's natural defenses
- The fungal infection can also be opportunistic, taking advantage of a compromised immune system or altered microbiome in the ear canal
- Prolonged therapy may be necessary to manage the infection, and treatment options may include a variety of topical therapeutic agents, such as cresylate, alcohol, nystatin, and amphotericin B 3% topical solution 1
From the Research
Clinical Presentations of Fungal Acute Otitis Externa
The clinical presentations of Fungal Acute Otitis Externa include:
- Itching, redness, swelling, and discharge in the ear canal, which can be severe and debilitating
- Otalgia (ear pain), which can be severe and radiate to the temporomandibular joint or face
- Temporary hearing loss or a sensation of fullness in the ear due to the blockage of the ear canal by fungal debris or inflammation
- Inflammation and potential spread to surrounding tissues if left untreated
- Otorrhea, otalgia, and/or pruritus, as seen in a case series of 11 patients with fungal otitis externa complicated by tympanic membrane perforation 2
- Tympanic membrane perforation, which can resolve with thorough debridement of the ear and proper medical treatment in most cases 2
Special Populations
Fungal infections of the external auditory canal can be especially important in certain populations, including:
- Patients with diabetes 3
- Patients recently treated with antibiotics 3
- Immunocompromised patients, such as those with AIDS or acute leukemia, who may require systemic antifungal therapy [@1@]
- Patients with diminished capacity for resisting infections, such as those with compromised immune systems or altered microbiome in the ear canal 4
Potential Pitfalls and Decision Forks
- Fungal Acute Otitis Externa can be a complication of bacterial otitis externa or other conditions that compromise the ear canal's natural defenses
- The fungal infection can also be opportunistic, taking advantage of a compromised immune system or altered microbiome in the ear canal
- Diagnosis can be challenging due to nonspecific signs and symptoms, and a high index of suspicion for fungal causes of ear canal disease is critical 3
- Proper identification of fungal pathogens is necessary to guide appropriate therapy 3
- Prolonged therapy may be necessary to manage the infection, and treatment options may include a variety of topical therapeutic agents 4, 2