From the Guidelines
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
- Localized vasodilation and increased blood flow to the affected area, leading to erythema (redness) and swelling
Special Considerations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal can occur, and systemic antifungal therapy may be necessary 1. 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
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. Some patients may be more prone to fungal infections, including otomycosis, if they have underlying conditions such as diabetes or are taking medications that alter the gut microbiome.
Decision Forks
The management of Fungal Acute Otitis Externa may involve decision forks, such as:
- The need for systemic antifungal therapy in immunocompromised patients versus local measures in immunocompetent patients
- The choice of topical therapeutic options, such as cresylate, alcohol, nystatin, or amphotericin B
- The potential need for surgical intervention in cases of complicated or refractory infection 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 2, 3, 4
- Otalgia (ear pain), which can be severe and radiate to the temporomandibular joint or face 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 2, 4
- Localized vasodilation and increased blood flow to the affected area, leading to erythema (redness) and swelling 2, 3
Special Considerations
In immunocompromised patients, such as those with diabetes or AIDS, invasive infection of the external ear canal can occur, and systemic antifungal therapy may be necessary 5. Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients 5.
Potential Pitfalls
Fungal Acute Otitis Externa can be a complication of bacterial otitis externa or other conditions that compromise the ear canal's natural defenses 3, 4. The fungal infection can also be opportunistic, taking advantage of a compromised immune system or altered microbiome in the ear canal 5. Some patients may be more prone to fungal infections, including otomycosis, if they have underlying conditions such as diabetes or are taking medications that alter the gut microbiome.
Decision Forks
The management of Fungal Acute Otitis Externa may involve decision forks, such as:
- The need for systemic antifungal therapy in immunocompromised patients versus local measures in immunocompetent patients 2, 3, 4
- The choice of topical therapeutic options, such as cresylate, alcohol, nystatin, or amphotericin B 2, 3
- The potential need for surgical intervention in cases of complicated or refractory infection 4
Nuances and Special Populations
Fungal Acute Otitis Externa can affect various populations, including:
- Immunocompromised patients, such as those with diabetes or AIDS 5
- Patients with a history of ear trauma or surgery 3
- Patients with underlying conditions that alter the gut microbiome, such as those taking antibiotics or immunosuppressive medications 5
- Patients with compromised ear canal defenses, such as those with eczema or psoriasis 3