From the Guidelines
Fungal otitis externa typically presents with symptoms such as 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.
- 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.
- Aspergillus otomycosis is most commonly attributable to A. niger and A. fumigatus, and A. niger may locally elaborate oxalic acid, a toxic metabolite, in the necrotic debris of the external auditory canal 1.
- Erosion and disruption of the epidermis may serve as a portal of entry for superinfection by opportunistic bacterial infections in immunocompromised patients 1.
Key Findings
- Aspergillus species may colonize the ceruminous debris in the external canal, with no resulting infection, but invasive infection of the external ear canal has been described in patients with AIDS and in patients with acute leukemia 1.
- Topical therapy using irrigations with acetic acid or boric acid, and topical antifungal creams and ointments, may be beneficial for treating fungal otitis externa 1.
- Systemic antifungal therapy may be necessary for immunocompromised patients or those with severe infections 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 but typically include:
- Unilateral, rarely bilateral, earache (otalgia) 2, 3
- Accompanying hearing loss 2
- Discharge from the ear (otorrhea) 2, 3
- Itching (pruritus) 3, 4
- Tympanic membrane perforation, which can be a complication of fungal otitis externa 3, 5
Common Fungal Causes
The most common fungi causing otomycosis (fungal otitis externa) are:
- Aspergillus species, including Aspergillus niger, Aspergillus flavus, and Aspergillus tubingensis 4, 5
- Candida species, including Candida albicans, Candida orthopsilosis, and Candida parapsilosis 4, 5
Patient Characteristics
Fungal otitis externa can affect anyone, but it is more common among:
- Males aged 21-40 years 4
- Manual workers and students 4
- Individuals with trauma to the external auditory canal 4
- Patients with compromised immune systems or other underlying health conditions (not specified in the provided studies)
Complications and Treatment
Fungal otitis externa can lead to serious complications, such as:
- Tympanic membrane perforation 3, 5
- Necrotising otitis externa (not specifically mentioned in the context of fungal otitis externa in the provided studies) Treatment typically involves:
- Thorough debridement of the ear 3
- Antifungal medication regimens 3, 5
- In some cases, surgery may be necessary to repair the tympanic membrane 3