From the Guidelines
Fungal acute otitis media typically presents with symptoms such as itching, fullness, and discharge in the ear, often accompanied by hearing loss. The presentation can be similar to bacterial otitis media, but fungal infections tend to have a more insidious onset and may be associated with a history of prolonged antibiotic use, immunocompromised state, or exposure to contaminated water.
Clinical Presentations
- Symptoms:
- Itching
- Fullness
- Discharge (often thick and yellowish or blackish in color, with a characteristic foul odor)
- Hearing loss
- Severe pain and discomfort (especially if the infection has spread to the surrounding tissues)
- Risk Factors:
- Prolonged antibiotic use
- Immunocompromised state
- Exposure to contaminated water
- History of recurrent bacterial otitis media
- Impaired mucosal or cutaneous immunity (e.g., hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection)
Diagnosis and Treatment
- Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane, as well as diagnostic modalities like pneumatic otoscopy, tympanometry, and audiometry 1.
- Treatment may involve topical antifungal creams or ointments, as well as orally administered antifungal medications like itraconazole, voriconazole, or posaconazole 1.
- Surgical debridement and drainage may be necessary in some cases, especially if the infection has spread to the surrounding tissues or if the patient has a compromised immune system 1. The evidence suggests that fungal acute otitis media can be a challenging condition to diagnose and treat, and a comprehensive approach that takes into account the patient's medical history, symptoms, and diagnostic test results is necessary for effective management 1.
From the Research
Clinical Presentations of Fungal Acute Otitis Media
- Fungal acute otitis media is a type of ear infection that can present with various clinical symptoms, including otalgia, fever, and irritability 2.
- The most common fungal pathogens isolated in otitis media are Candida albicans 3 and Aspergillus spp. 4.
- Fungal otitis media can be diagnosed in patients with chronic inflammatory ear pathology, and it is often associated with mold fungi dominated by the genus Aspergillus spp. 4.
- The clinical manifestations of fungal acute otitis media can range from mild to severe, and they may include symptoms such as ear discharge, hearing loss, and tympanic membrane erythema 5, 6.
Diagnosis and Treatment
- The diagnosis of fungal acute otitis media is often based on clinical examination, microbiological culture, and drug susceptibility testing 3.
- The treatment of fungal acute otitis media depends on the severity of the infection and the causative fungal agent, and it may include topical antifungal agents, systemic antifungal therapy, or surgical intervention 4.
- The authors describe modern schemes for the treatment of otomycosis, including the use of antifungal agents and surgical procedures 4.
Epidemiology and Pathogenesis
- Fungal acute otitis media is a common diagnosis in patients with chronic inflammatory ear pathology, and it is often associated with underlying conditions such as immunosuppression or previous ear surgery 4.
- The pathogenesis of fungal acute otitis media is complex and involves the interaction of various factors, including the fungal pathogen, the host immune response, and the middle ear environment 5, 6.
- The development of fungal acute otitis media is often preceded by a viral or bacterial infection, and it may be influenced by factors such as antibiotic use, immunosuppression, and anatomic abnormalities of the middle ear 5, 6, 2.