From the Guidelines
Fungal otitis externa typically presents with symptoms such as pruritus, pain, hypoacusis, and otic discharge, which can be similar to those of bacterial otitis externa. Patients may complain of itching, fullness, or discomfort in the affected ear, accompanied by a visible discharge or debris in the ear canal, which can be white, yellow, or black, depending on the type of fungus involved, and may have a characteristic musty or fungal odor 1. The ear canal may appear edematous, erythematous, or have visible fungal growth, such as a cotton ball-like appearance, on examination.
- Common symptoms include:
- Pruritus
- Pain
- Hypoacusis (hearing loss)
- Otic discharge
- The discharge can be:
- White
- Yellow
- Black
- Have a characteristic musty or fungal odor
- The ear canal may appear:
- Edematous
- Erythematous
- Have visible fungal growth It is essential to consider fungal otitis externa in the differential diagnosis of otitis externa, particularly in patients who do not respond to conventional antibiotic therapy, and to perform a thorough examination, including microscopic analysis of the discharge or debris, to confirm the diagnosis 1.
From the Research
Clinical Presentations of Fungal Otitis Externa
The clinical presentations of fungal otitis externa, an infection of the outer ear, can vary. Some common symptoms include:
- Unilateral, rarely bilateral, earache (otalgia) 2
- Accompanying hearing loss 2
- Discharge from the ear (otorrhea) 2, 3
- Itching, which was the most common presenting complaint in one study 4
- Pruritus 3
Predisposing Factors and Complications
Some predisposing factors and complications of fungal otitis externa include:
- Trauma to the external auditory canal, which was the most common predisposing factor in one study 4
- Tympanic membrane perforation, which was found to be more common with otomycosis caused by certain fungi such as Aspergillus flavus, A. tubingensis, and Candida albicans 5
- Necrotizing otitis externa, a life-threatening condition 6
Patient Characteristics
Fungal otitis externa can affect various populations, including:
- Males aged 21-40 years, who were more commonly affected in one study 4
- Manual workers and students, who had the highest frequency based on occupational incidence in one study 4
- Patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients, who may be at higher risk of fungal infections of the ear canal 6