From the Guidelines
Fungal acute external otitis typically presents with pruritus, pain, hypoacusis, and otic discharge, as described in the study by 1. The discharge is often thick and yellowish or blackish in color, and may have a foul odor. Additionally, patients may experience hearing loss or a sensation of fullness in the ear due to the blockage of the ear canal by the fungal growth and debris.
Common Symptoms
- Pruritus: itching sensation in the ear canal
- Pain: discomfort or tenderness in the ear canal
- Hypoacusis: hearing loss due to blockage of the ear canal
- Otic discharge: thick, yellowish or blackish discharge from the ear canal
Fungal Causes
The most common causes of fungal acute external otitis are Aspergillus niger and Aspergillus fumigatus, as noted in the study by 1. These fungi can produce toxic metabolites, such as oxalic acid, which can exacerbate the infection.
Treatment Options
Treatment options for fungal acute external otitis include topical antifungal creams and ointments, as well as orally administered antifungal medications such as itraconazole, voriconazole, or posaconazole, as mentioned in the study by 1. However, the effectiveness of these treatments has not been well studied, and more research is needed to determine the best course of treatment.
High-Risk Patients
Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, are more susceptible to fungal acute external otitis, as noted in the study by 1. These patients may require more aggressive treatment and closer monitoring to prevent complications.
From the Research
Presentation of Fungal Acute External Otitis
The presentation of fungal acute external otitis can be identified by the following symptoms:
- Pruritus (itching)
- Otalgia (ear pain)
- Aural fullness
- Hearing impairment
- Otorrhea (discharge from the ear)
- Tinnitus (ringing in the ear) 2
- Unilateral earache, rarely bilateral, with accompanying hearing loss and sometimes discharge from the ear (otorrhea) 3
Causes and Complications
Fungal acute external otitis is caused by fungal invasion, with the most common fungi being Aspergillus and Candida species 4. It can lead to serious complications, such as necrotising external otitis, which requires prompt medical attention 4.
Fungal Species Involved
The fungal species involved in acute external otitis include:
- Aspergillus species, with Aspergillus niger being the most common agent 2
- Candida species, with Candida albicans being more prevalent than other yeast species 2
- Other saprophytic fungi 2
- Coinfection with Candida auris and Aspergillus flavus, which can make diagnosis and treatment more complex and difficult 5
Treatment
Treatment of fungal acute external otitis involves local care, ear drops, and, in severe cases, systemic antifungal medications 4, 5, 6.