From the Guidelines
Fungal otitis externa, also known as otomycosis, typically presents with symptoms such as pruritus, pain, hypoacusis, and otic discharge, which can be white, yellow, or black in color and may have a characteristic musty or moldy odor. The clinical presentation of fungal otitis externa can vary, with some patients experiencing mild symptoms such as occasional itching or a sensation of ear fullness, while others may present with more severe symptoms, including significant inflammation and swelling of the external auditory canal, leading to narrowing of the canal and potential hearing loss 1.
Common Symptoms
- Pruritus
- Pain
- Hypoacusis
- Otic discharge (white, yellow, or black in color)
- Musty or moldy odor
Patient Factors
Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, are more susceptible to fungal otitis externa and may present with more severe or atypical symptoms 1.
Treatment
Treatment of fungal otitis externa typically involves thorough mechanical cleansing of the external auditory canal followed by topical antifungals or boric acid 1. In some cases, systemic antifungal therapy may be necessary, particularly in immunocompromised patients or those with invasive infections 1.
Fungal Species
Aspergillus species, such as A. niger and A. fumigatus, are commonly associated with fungal otitis externa, and may produce toxins that can cause more severe symptoms, such as vertigo or tinnitus 1.
From the Research
Clinical Presentations of Fungal Otitis Externa
The clinical presentations of fungal otitis externa, also known as otomycosis, can vary depending on the causative fungal agent and the individual patient. Some common presenting complaints include:
- Itching, as reported in the study by 2
- Earache (otalgia) and hearing loss, as mentioned in the study by 3
- Discharge from the ear (otorrhea), also noted in the study by 3
- Trauma to the external auditory canal, which can be a predisposing factor, as found in the study by 2
Causative Fungal Agents
The most common causative fungal agents of otomycosis include:
- Aspergillus species, such as Aspergillus niger, which was found to be the most common fungus causing otomycosis in the study by 2
- Candida species, which were also identified as causative agents in the studies by 4, 5
- Other mold fungi, which were found to be predominant in patients with external fungal otitis, as reported in the study by 5
Patient Populations
Certain patient populations may be more susceptible to fungal infections of the external auditory canal, including:
- Patients with diabetes, as mentioned in the study by 6
- Patients recently treated with antibiotics, also noted in the study by 6
- Immunocompromised patients, who may be at risk for opportunistic fungal infections, as reported in the study by 6
- Manual workers and students, who had the highest frequency of otomycosis based on occupational incidence, as found in the study by 2