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, and otic discharge, and may involve the middle ear if the tympanic membrane has been perforated 1.
- Aspergillus otomycosis is a common cause of fungal acute external otitis, and is most commonly attributable to A. niger and A. fumigatus 1.
- Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, are susceptible to recurrent bacterial otitis media, otitis externa, and Aspergillus otomycosis 1.
- 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, although data describing treatment outcomes are limited 1.
- In severe cases, orally administered itraconazole, voriconazole, or posaconazole may be effective, although there are no published studies that 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:
- Itching as the most common presenting complaint 2
- Unilateral, rarely bilateral, earache (otalgia) 3, 4
- Accompanying hearing loss 3, 4
- Sometimes discharge from the ear (otorrhea) 3, 4, 5
- Fullness in the ear 4
- Tenderness with movement of the tragus or pinna, which is a hallmark sign of acute otitis externa 4
Causative Agents
The most common fungi causing otomycosis are:
- Aspergillus niger, which was found to be the most common fungus in a study of 110 patients with otomycosis 2
- Aspergillus and Candida species, which are also commonly involved in external otitis 6
Predisposing Factors
Trauma to the external auditory canal is a common predisposing factor for otomycosis 2