What is the presentation of fungal acute external otitis?

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, also known as otomycosis, typically includes:

• Unilateral infection, affecting one ear more commonly than both ears 2, 3
• Symptoms such as:
  • Pruritus (itching) 2, 3
  • Otalgia (earache) 2, 3
  • Aural fullness 2
  • Hearing impairment 2
  • Otorrhea (discharge from the ear) 2
  • Tinnitus 2
• Fungal species commonly involved include:
  • Aspergillus species, with Aspergillus niger being the most common agent 2, 3
  • Candida species, with Candida albicans being more prevalent than other yeast species 2
• The infection is often secondary and more prevalent among individuals who swim frequently, with a higher incidence reported in summer seasons 2, 3

Demographic Factors

The presentation of fungal acute external otitis can vary depending on demographic factors, such as:

• Age: The infection is more prevalent among individuals aged 20-40 years, with the lowest prevalence associated with being under 10 years old 2
• Sex: The sex ratio of otomycosis can vary, with some studies reporting a higher incidence among females 2 and others reporting a ratio of 1:1.53 (M:F) 2
• Occupation: Manual workers and students have been reported to have a higher frequency of otomycosis based on occupational incidence 3