What are the clinical presentations of fungal acute otitis externa (infection of the outer ear)?

From the Guidelines

Fungal acute otitis externa typically presents with pruritus, pain, hypoacusis, and otic discharge.

Clinical Presentations

• The infection usually involves the external auditory canal and may involve the middle ear if the tympanic membrane has been perforated 1.
• Aspergillus species, particularly A. niger and A. fumigatus, are commonly associated with this condition 1.
• Patients with impaired mucosal or cutaneous immunity, such as those with hypogammaglobulinemia, diabetes mellitus, chronic eczema, or HIV infection, are more susceptible to fungal acute otitis externa 1.
• If left untreated, the infection can lead to chronic fungal mastoiditis 1.

Treatment

• Topical therapy with acetic acid or boric acid irrigations may be beneficial 1.
• Topical antifungal creams and ointments, such as nystatin, amphotericin B, and clotrimazole, may be useful, but their effectiveness is not well studied 1.
• Oral antifungal agents, such as itraconazole, voriconazole, or posaconazole, may be effective, but there is limited evidence to support their use 1.

From the Research

Clinical Presentations of Fungal Acute Otitis Externa

The clinical presentations of fungal acute otitis externa can vary, but common symptoms include:

• Unilateral, rarely bilateral, earache (otalgia) 2, 3
• Accompanying hearing loss 2
• Discharge from the ear (otorrhea) 2, 4
• Pruritus (itching) 4

Fungal Pathogens Involved

The most common fungi involved in otitis externa are:

• Aspergillus species 3, 5
• Candida species 3, 5

Patient Populations at Risk

Certain populations are at higher risk for fungal infections of the external auditory canal, including:

• Patients with diabetes 6
• Patients recently treated with antibiotics 6
• Immunosuppressed patients 6

Complications

Fungal otitis externa can lead to serious complications, such as:

• Necrotizing otitis externa, which requires prompt medical attention 3
• Tympanic membrane perforation, which may resolve with proper treatment or require surgery 4