From the Guidelines
Clinical Presentations of Fungal Acute Otitis Externa (AOE)
The clinical presentations of Fungal Acute Otitis Externa (AOE) include:
- Pruritus
- Pain
- Hypoacusis
- Otic discharge
- Itching, fullness, and discharge in the ear canal, often accompanied by a foul odor
- Edematous and erythematous ear canal with visible fungal elements such as white or yellowish debris
- Hearing loss or a sensation of fullness due to the blockage of the ear canal by fungal material
Special Populations
Patients with impaired mucosal or cutaneous immunity, such as those with:
- Hypogammaglobulinemia
- Diabetes mellitus
- Chronic eczema
- HIV infection
- Those who receive corticosteroids are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis.
Potential Pit-Falls
If the otomycotic process is not successfully treated and the underlying predisposing immune impairment and anatomic defects are not corrected, Aspergillus hyphae and conidia may extend into the mastoid sinus, creating a chronic fungal mastoiditis 1. Erosion and disruption of the epidermis may serve as a portal of entry for superinfection by opportunistic bacterial infections in immunocompromised patients 1.
Decision Forks
In immunocompromised patients, systemic antifungal therapy appears necessary 1. However, infections of lesser severity (without tissue invasion) or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal 1. Topical therapy using irrigations with acetic acid or boric acid are described as being beneficial 1. Topical antifungal creams and ointments are not well studied but may be useful for this condition 1. Orally administered itraconazole, voriconazole, or posaconazole may be effective; however, there are no published studies that support their use 1.
From the Research
Clinical Presentations of Fungal Acute Otitis Externa (AOE)
The clinical presentations of Fungal Acute Otitis Externa (AOE) include:
- Pruritus
- Pain
- Hypoacusis
- Otic discharge
- Itching, fullness, and discharge in the ear canal, often accompanied by a foul odor
- Edematous and erythematous ear canal with visible fungal elements such as white or yellowish debris
- Hearing loss or a sensation of fullness due to the blockage of the ear canal by fungal material
Special Populations
Patients with impaired mucosal or cutaneous immunity, such as those with:
- Hypogammaglobulinemia
- Diabetes mellitus
- Chronic eczema
- HIV infection
- Those who receive corticosteroids are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis.
Potential Pit-Falls
If the otomycotic process is not successfully treated and the underlying predisposing immune impairment and anatomic defects are not corrected, Aspergillus hyphae and conidia may extend into the mastoid sinus, creating a chronic fungal mastoiditis 2. Erosion and disruption of the epidermis may serve as a portal of entry for superinfection by opportunistic bacterial infections in immunocompromised patients 2.
Decision Forks
In immunocompromised patients, systemic antifungal therapy appears necessary [@2@]. However, infections of lesser severity (without tissue invasion) or those that occur in immunocompetent patients may be managed with local measures, including cerumen removal [@2@]. Topical therapy using irrigations with acetic acid or boric acid are described as being beneficial 2. Topical antifungal creams and ointments are not well studied but may be useful for this condition 2. Orally administered itraconazole, voriconazole, or posaconazole may be effective; however, there are no published studies that support their use 2.
Nuances
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. Aspergillus species, particularly A. niger and A. fumigatus, are commonly involved in otomycosis 2.
Fungal Involvement
Aspergillus otomycosis is most commonly attributable to A. niger and A. fumigatus 2. A. niger, which is a known cause of in vivo production of oxalic acid, may locally elaborate this toxic metabolite in the necrotic debris of the external auditory canal 2.