From the Guidelines
Clinical Presentations of Fungal Acute Otitis Externa
Fungal acute otitis externa typically presents with:
- Itching, fullness, and discharge in the ear canal, often accompanied by a foul odor
- The ear canal may appear edematous and erythematous, with visible fungal elements such as white or yellowish debris
- Patients may also experience hearing loss or a sensation of fullness due to the blockage of the ear canal by fungal material
Special Populations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal has been described 1. These patients may require systemic antifungal therapy.
Decision Forks
The management of fungal acute otitis externa may depend on the severity of the infection and the patient's immune status. Infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal and topical therapeutic options 1. However, in immunocompromised patients or those with severe infections, systemic antifungal therapy may be necessary.
Potential Pit-Falls
It is essential to differentiate fungal acute otitis externa from other forms of otitis externa, such as bacterial or viral infections, to ensure appropriate treatment. Additionally, the presence of fungal elements in the ear canal does not always indicate an infection, as some fungi may colonize the ceruminous debris without causing disease 1.
From the Research
Clinical Presentations of Fungal Acute Otitis Externa
Fungal acute otitis externa typically presents with:
- Itching, fullness, and discharge in the ear canal, often accompanied by a foul odor
- The ear canal may appear edematous and erythematous, with visible fungal elements such as white or yellowish debris
- Patients may also experience hearing loss or a sensation of fullness due to the blockage of the ear canal by fungal material
- Otorrhea, otalgia, and/or pruritus are common symptoms, as reported in a case series of 11 patients with fungal otitis externa complicated by tympanic membrane perforation 2
- Fungal infections of the external auditory canal can pose a great clinical challenge both in diagnosis and in therapy, and most infections present in patients who have undergone previous medical treatment of the external canal, which has changed the pH and normal canal flora, or in those who have diminished capacity for resisting infections 3
Special Populations
In immunocompromised patients, such as those with AIDS or acute leukemia, invasive infection of the external ear canal has been described 4. These patients may require systemic antifungal therapy.
- Fungal malignant otitis externa (FMOE) is a rare but serious condition that can affect immunocompromised individuals, with a mean age of 65.9 years and a high proportion of males (72.6%) 5
- Underlying immunosuppressive conditions, such as diabetes mellitus, chronic kidney failure, corticosteroid use, chemotherapy, and AIDS, are common in patients with FMOE 5
Decision Forks
The management of fungal acute otitis externa may depend on the severity of the infection and the patient's immune status.
- Infections of lesser severity or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal and topical therapeutic options 3, 6
- Systemic antifungal therapy may be necessary in immunocompromised patients or those with severe infections, such as FMOE 5
- Conservative treatment, including local toilet of the external auditory canal and the use of systemic antifungal agents, is the mainstay of therapy for fungal otitis externa 6, 2
Potential Pit-Falls
It is essential to differentiate fungal acute otitis externa from other forms of otitis externa, such as bacterial or viral infections, to ensure appropriate treatment.
- The presence of fungal elements in the ear canal does not always indicate an infection, as some fungi may colonize the ceruminous debris without causing disease 3
- Late diagnosis, cranial nerve involvement, and inadequate treatment may contribute to higher mortality in patients with FMOE 5
- Opportunistic fungal infections of the ear canal are an emerging concern, particularly in patients with diabetes, those recently treated with antibiotics, and immunosuppressed patients 7