What are the external presentations of fungal acute otitis externa (outer ear infection)?

From the Guidelines

Fungal acute otitis externa typically presents with itching, fullness, and discharge in the ear canal, as well as pruritus, pain, hypoacusis, and otic discharge 1. The discharge is often described as thick and yellowish or blackish in color, and may have a foul odor.

Key Symptoms

• Itching
• Fullness
• Discharge
• Pruritus
• Pain
• Hypoacusis
• Otic discharge

Causes and Risk Factors

The infection is usually caused by Aspergillus species, such as A. niger and A. fumigatus 1, and can be more common in patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, as well as those who receive corticosteroids 1.

Treatment Options

Treatment options for fungal acute otitis externa include topical therapy using irrigations with acetic acid or boric acid, as well as topical antifungal creams and ointments 1. In some cases, orally administered itraconazole, voriconazole, or posaconazole may be effective, although there are no published studies to support their use 1.

From the Research

External Presentations of Fungal Acute Otitis Externa

The external presentations of fungal acute otitis externa (outer ear infection) include:

• Unilateral infection, affecting more females than males 2
• Symptoms such as pruritus, otalgia, aural fullness, hearing impairment, otorrhea, and tinnitus 2, 3
• Fungal species such as yeasts, molds, dermatophytes, and Malassezia species as agents for otitis externa, with Aspergillus niger being the most common agent 2, 3
• Candida albicans being more prevalent than other yeast species 2
• Higher prevalence rates in areas with tropical and subtropical climate, and among swimmers 2
• Incidence of otomycosis ranging from 5.7 to 81%, with a mean value of 51.3% 2
• Presenting complaints such as itching, with trauma to the external auditory canal being a common predisposing factor 3

Common Fungal Agents

The most common fungal agents causing otomycosis include:

• Aspergillus niger 2, 3
• Candida species 2, 3, 4
• Other saprophytic fungi 2

Patient Profile

The epidemiological profile of otomycosis infection varies according to different factors, including:

• Age: highest incidence among 20-40 years old 2
• Sex: higher incidence among females, with a sex ratio of 1:1.53 2
• Occupation: higher incidence among manual workers and students 3
• Season: higher incidence in summer and spring seasons 2, 3