From the Guidelines
The clinical presentations of fungal otitis externa typically include itching, discomfort, and a sensation of fullness in the ear, often accompanied by a visible fungal growth or discharge, which can be white, yellow, or black in color, and may have a musty or foul odor.
- Symptoms of fungal otitis externa, as described in the study by 1, include pruritus, pain, hypoacusis, and otic discharge.
- The condition may be more resistant to treatment and often occurs in individuals with a history of prolonged use of antibiotics or ear drops, which can disrupt the normal bacterial flora of the ear and create an environment conducive to fungal growth.
- Aspergillus otomycosis is a common cause of fungal otitis externa, with A. niger and A. fumigatus being the most common species involved, as noted in the study by 1.
- Treatment options for fungal otitis externa include topical antifungal creams and ointments, as well as orally administered antifungal medications such as itraconazole, voriconazole, or posaconazole, although there are limited studies supporting their use, as mentioned in the study by 1.
- In immunocompromised patients, systemic antifungal therapy may be necessary, while in immunocompetent patients, local measures such as cerumen removal and topical therapeutic options may be sufficient, as described in the study by 1.
From the Research
Clinical Presentations of Fungal Otitis Externa
The clinical presentations of fungal otitis externa, an infection of the outer ear, can vary but typically include:
- Pruritus (itching) as the most common presenting complaint 2
- Local discomfort or pain in the ear
- Discharge or debris in the ear canal
- Edema (swelling) of the ear canal
- Trauma to the external auditory canal as a predisposing factor 2
- Tympanic membrane perforation, which can occur in approximately 6.75% of cases, more commonly with certain fungal species such as Aspergillus flavus, A. tubingensis, and Candida albicans 3
Fungal Species Involved
The most common fungi involved in otitis externa include:
- Aspergillus species, such as Aspergillus niger, Aspergillus flavus, and Aspergillus tubingensis 4, 2, 3
- Candida species, such as Candida albicans, Candida orthopsilosis, and Candida parapsilosis 4, 3, 5
- Coinfections with multiple fungal species can also occur, such as Candida auris and Aspergillus flavus 5
Seasonal and Occupational Variations
The incidence of fungal otitis externa can vary by season, with higher rates in summer and spring 2, and by occupation, with higher frequencies among manual workers and students 2