From the Guidelines

H2: Clinical Presentations of Fungal Acute Otitis Externa (AOE)

The clinical presentations of Fungal AOE include:

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
Pruritus, pain, hypoacusis, and otic discharge are common symptoms of Aspergillus otomycosis, as reported in the study 1
Aspergillus species, such as A. niger and A. fumigatus, are the most common causes of Aspergillus otomycosis, as mentioned in the study 1

Special populations that are susceptible to Fungal AOE include:

Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection
Immunocompromised patients, such as those with AIDS or acute leukemia, are at risk of developing invasive otic infections, including Aspergillus mastoiditis, as described in the study 1
Patients with prosthetic valves, central venous catheters, permanent pacemakers, and defibrillators may also be at risk of developing fungal infective endocarditis, as noted in the study 1

The clinical presentations of Fungal AOE include:

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
Otalgia, itching, fullness, and sometimes hearing loss are common symptoms of AOE, as reported in the study 2
Tenderness with movement of the tragus or pinna is a hallmark sign of AOE, as mentioned in the study 2
Fungal AOE can be caused by various fungi, including Aspergillus and Candida species, as noted in the study 3
Aspergillus species, such as Aspergillus flavus, Aspergillus niger, are common causes of Fungal AOE, as reported in the study 4

Special populations that are susceptible to Fungal AOE include:

Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection
Immunocompromised patients, such as those with AIDS or acute leukemia, are at risk of developing invasive otic infections, including Aspergillus mastoiditis
Patients with a history of trauma or use of topical antibiotics may also be at risk of developing Fungal AOE, as noted in the study 4
Children older than 2 years are more susceptible to AOE, while children under the age of 2 have little morbidity, as reported in the study 2