What are the clinical presentations of Fungal Acute Otitis Externa (External Ear Infection)?

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From the Guidelines

Fungal Acute Otitis Externa (External Ear Infection) 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 Acute Otitis Externa include:

  • Pruritus (itching)
  • Pain
  • Hypoacusis (hearing loss)
  • Otic discharge, which may have a characteristic odor and appearance, such as a cotton-like or cheesy texture
  • Visible fungal infection, such as a white, yellow, or black discharge

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

Treatment

Treatment options for Fungal Acute Otitis Externa include:

  • Topical therapy using irrigations with acetic acid or boric acid
  • Topical antifungal creams and ointments, such as nystatin, clotrimazole, and ketoconazole
  • Orally administered antifungal medications, such as itraconazole, voriconazole, or posaconazole, which may be effective in severe cases or in immunocompromised patients 1.

From the Research

Clinical Presentations of Fungal Acute Otitis Externa

The clinical presentations of Fungal Acute Otitis Externa (External Ear Infection) can vary, but common symptoms include:

  • Otorrhea (discharge from the ear) 2
  • Otalgia (ear pain) 2
  • Pruritus (itching) 2
  • Tympanic membrane perforation (a hole in the eardrum) 2

Patient Populations

Fungal pathogens may be an especially important cause of ear canal disease in certain populations, including:

  • Patients with diabetes 3
  • Patients recently treated with antibiotics 3
  • Immunocompromised patients 3

Diagnosis and Treatment

Diagnosis is made by clinical inspection and selective cultures 4. Therapy consists of:

  • Complete cleaning of the ear 2, 4
  • Use of topical antimycotic agents 4
  • Systemic therapy is rarely required 4
  • In some cases, surgery may be necessary to repair a perforated tympanic membrane 2

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Fungal Infections of the External Auditory Canal and Emerging Pathogens.

Otolaryngologic clinics of North America, 2023

Research

Fungal infections of the external ear.

Otolaryngologic clinics of North America, 1993

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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