From the Guidelines
Fungal acute external otitis typically presents with itching, fullness, and discharge in the ear canal, accompanied by a visible fungal growth or a white, yellow, or black discharge, which can be seen in the ear canal upon examination 1. The symptoms of fungal acute external otitis include:
- Pruritus
- Pain
- Hypoacusis
- Otic discharge These symptoms occur due to the fungal infection causing inflammation and swelling of the ear canal, while the discharge is a result of the fungal growth and the body's attempt to fight off the infection.
Causes and Risk Factors
Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, and those who receive corticosteroids, are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis 1.
Treatment
Treatment options for fungal acute external otitis 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
Presentation of Fungal Acute External Otitis
The presentation of fungal acute external otitis can be identified by the following symptoms:
- Pruritus (itching)
- Otalgia (earache)
- Aural fullness
- Hearing impairment
- Otorrhea (discharge from the ear)
- Tinnitus (ringing in the ear) 2
- Erythema (redness) and swelling of the canal with variable discharge 3
Causes and Risk Factors
Fungal acute external otitis is usually caused by fungal species such as yeasts, molds, dermatophytes, and Malassezia species, with Aspergillus niger and Candida albicans being the most common agents 2. The infection is often secondary and more prevalent among swimmers, with a higher incidence reported in summer 2.
Diagnosis and Treatment
Diagnosis involves thorough cleansing of the canal, and treatment typically includes topical application of an acidifying solution, antimicrobial-containing ototopical, or oral antibiotic therapy in advanced cases 4, 3, 5. Preventive measures, such as minimizing ear canal moisture and trauma, can reduce recurrences 3, 5.