From the Guidelines
Fungal Acute Otitis Externa (AOE) typically presents with symptoms such as pruritus, pain, hypoacusis, and otic discharge, often accompanied by a visible fungal infection.
Clinical Presentations
The clinical presentations of Fungal AOE include:
- Pruritus: itching sensation in the ear canal
- Pain: discomfort or pain in the ear canal
- Hypoacusis: decreased hearing or fullness in the ear
- Otic discharge: discharge from the ear canal, which may have a characteristic odor and appearance, such as a cotton-like or cheesy texture
Associated Factors
These symptoms may be associated with a history of:
- Swimming
- Trauma to the ear canal
- Use of earplugs or hearing aids
- Impaired mucosal or cutaneous immunity, such as in patients with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection
- Use of corticosteroids
Fungal Involvement
Fungal AOE is most commonly caused by Aspergillus niger and Aspergillus fumigatus 1. These fungi can produce toxic metabolites, such as oxalic acid, which can contribute to the disease process.
Treatment
Treatment options for Fungal AOE include:
- Topical therapy with acetic acid or boric acid irrigations
- Topical antifungal creams and ointments, such as clotrimazole or ketoconazole
- Orally administered antifungal agents, such as itraconazole, voriconazole, or posaconazole, may be effective in severe cases 1.
From the Research
Clinical Presentations of Fungal Acute Otitis Externa (AOE)
The clinical presentations of Fungal Acute Otitis Externa (AOE) are not explicitly described in the provided studies as separate entities from bacterial AOE. However, the symptoms of AOE in general can be outlined as follows:
- Otalgia (ear pain) 2, 3
- Itching 2
- Fullness in the ear 2, 3
- Hearing loss 2, 3
- Tenderness with movement of the tragus or pinna, which is considered a hallmark sign of AOE 2
- Otorrhea (discharge from the ear) 3
Fungal Involvement in AOE
While the studies do not specifically detail the clinical presentations of fungal AOE, they do mention that fungi, such as Aspergillus and Candida species, can be involved in the condition 4. The presence of fungi can influence the presentation and treatment of AOE, but specific details on fungal AOE are not provided in the given evidence.
General Considerations
AOE can occur in adults or children older than the age of 2, with little morbidity in children under the age of 2 2. The lifetime incidence of AOE is up to 10% in a person's life 2. Treatment of AOE focuses on analgesia, treating the underlying infection, and preventing recurrence 3.