From the Guidelines
Clinical Presentations of Fungal Acute Otitis Externa
Fungal acute otitis externa is an infection of the outer ear canal, typically caused by fungal organisms such as Aspergillus or Candida. The clinical presentations of this condition can be broken down into several relevant systems:
- Infectious/Inflammatory/Infiltrative: Presentation may include itching, redness, swelling, and discharge from the ear canal. The infection can cause inflammation and infiltration of the ear canal, leading to symptoms such as pain, tenderness, and difficulty hearing.
- Neurology: The infection can cause irritation of the nerves in the ear canal, leading to symptoms such as itching, burning, or tingling sensations. In rare cases, the infection can spread to the surrounding nerves, causing more severe neurological symptoms such as facial weakness or numbness.
- Vascular/Hematology: The infection can cause increased blood flow to the affected area, leading to redness, swelling, and warmth. There may also be an increase in white blood cell count in response to the infection.
- Gastrointestinal: Although not directly related, some medications used to treat fungal infections, such as antifungals, can have gastrointestinal side effects such as nausea, vomiting, or diarrhea.
- Drug-effect: Treatment of fungal acute otitis externa often involves the use of antifungal medications, which can have side effects such as allergic reactions, skin rash, or interactions with other medications.
Special Populations
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. In contrast, infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal.
Potential Pitfalls
It is essential to note that fungal acute otitis externa can be caused by various fungal organisms, and the presentation may vary depending on the specific organism involved. Additionally, the infection can spread to surrounding structures, such as the mastoid, leading to more severe complications. Therefore, prompt diagnosis and treatment are crucial to prevent long-term sequelae.
From the Research
Clinical Presentations of Fungal Acute Otitis Externa
The clinical presentations of fungal acute otitis externa can be broken down into several relevant systems, including:
- Infectious/Inflammatory/Infiltrative: Presentation may include itching, redness, swelling, and discharge from the ear canal, as well as inflammation and infiltration of the ear canal, leading to symptoms such as pain, tenderness, and difficulty hearing 2, 3, 4, 5.
- Neurology: The infection can cause irritation of the nerves in the ear canal, leading to symptoms such as itching, burning, or tingling sensations, and in rare cases, more severe neurological symptoms such as facial weakness or numbness.
- Vascular/Hematology: The infection can cause increased blood flow to the affected area, leading to redness, swelling, and warmth, as well as an increase in white blood cell count in response to the infection.
Special Populations
Fungal infections of the external auditory canal can be especially important in certain populations, including:
- Patients with diabetes
- Patients recently treated with antibiotics
- Immunocompromised patients, such as those with AIDS or acute leukemia, who may require systemic antifungal therapy 5. In these cases, the infection can be more severe and may require prompt medical attention.
Potential Pitfalls
It is essential to note that fungal acute otitis externa can be caused by various fungal organisms, and the presentation may vary depending on the specific organism involved 3, 4, 5. Additionally, the infection can spread to surrounding structures, such as the mastoid, leading to more severe complications, and may require thorough debridement of the ear and antifungal medication regimens 4. Therefore, prompt diagnosis and treatment are crucial to prevent long-term sequelae.
Nuances
The diagnosis of fungal acute otitis externa can be challenging, and a high index of suspicion for fungal causes of ear canal disease is critical 5. The infection can present with nonspecific signs and symptoms, such as otorrhea, otalgia, and/or pruritus, making diagnosis difficult for both primary care physicians and general otolaryngologists 4. Proper identification of fungal pathogens is necessary to guide appropriate therapy, and treatment involves local care, ear drops, and, in severe cases, systemic antibiotics or antifungal medications 2, 3, 4, 5.