From the Guidelines
H2: 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 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
- Localized vasodilation and increased blood flow to the affected area, leading to erythema (redness) and swelling
H3: Special Considerations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal has been described 1. Systemic antifungal therapy appears necessary in these cases. However, infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal. A variety of topical therapeutic options have been used, including cresylate, alcohol, nystatin, amphotericin B, boric acid, thymol, gentian violet, and clotrimazole. Prolonged therapy may be necessary in these cases.
Potential pitfalls to consider include:
- Invasive infection of the external ear canal in immunocompromised patients
- Opportunistic infection taking advantage of a compromised immune system or altered microbiome in the ear canal
- Complication of bacterial otitis externa or other conditions that compromise the ear canal's natural defenses
- Underlying conditions such as diabetes that may increase the risk of fungal infections, including otomycosis.
From the Research
H2: 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 2, 3, 4, 5
- Otalgia (ear pain), which can be severe and radiate to the temporomandibular joint or face 6, 4
- Temporary hearing loss or a sensation of fullness in the ear due to the blockage of the ear canal by fungal debris or inflammation 6, 4
- Localized vasodilation and increased blood flow to the affected area, leading to erythema (redness) and swelling 7, 6
H3: Special Considerations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal has been described [@1@]. Systemic antifungal therapy appears necessary in these cases. However, infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal. Some patients may be more prone to fungal infections, including otomycosis, if they have underlying conditions such as diabetes 5. The fungal infection can also be opportunistic, taking advantage of a compromised immune system or altered microbiome in the ear canal 2, 3, 4, 5.
H3: Nuances and Pitfalls
Potential pitfalls to consider include:
- Invasive infection of the external ear canal in immunocompromised patients [@1@]
- Opportunistic infection taking advantage of a compromised immune system or altered microbiome in the ear canal 2, 3, 4, 5
- Complication of bacterial otitis externa or other conditions that compromise the ear canal's natural defenses 7, 6
- Underlying conditions such as diabetes that may increase the risk of fungal infections, including otomycosis 5
- Tympanic membrane perforation, which can occur as a complication of fungal otitis externa 4
H3: Special Populations
Special populations that may be at higher risk for Fungal Acute Otitis Externa include:
- Immunocompromised patients, such as those with AIDS or acute leukemia [@1@]
- Patients with underlying conditions such as diabetes 5
- Patients who have undergone previous medical treatment of the external canal, which has changed the pH and normal canal flora 2
- Patients who have diminished capacity for resisting infections 2