From the Guidelines
Fungal otitis externa typically presents with pruritus, pain, hypoacusis, and otic discharge.
Clinical Presentations
- The infection usually involves the external auditory canal and may extend to the middle ear if the tympanic membrane is perforated.
- Aspergillus species, such as 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, or HIV infection, are more susceptible to fungal otitis externa 1.
Symptoms and Complications
- Symptoms may include pruritus, pain, hypoacusis, and otic discharge 1.
- If left untreated, the infection may lead to chronic fungal mastoiditis 1.
- Superinfection by opportunistic bacterial infections may occur in immunocompromised patients 1.
Treatment
- Topical therapy with acetic acid or boric acid irrigations, as well as topical antifungal creams and ointments, may be beneficial 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 Otitis Externa
The clinical presentations of fungal otitis externa, an infection of the outer ear canal, can vary but typically 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 5
Predisposing Factors and Complications
Fungal otitis externa can be caused by various factors, including:
- Trauma to the external auditory canal, which was the most common predisposing factor in one study 4
- Fungal pathogens, such as Aspergillus and Candida species 6, 4, 3
- Opportunistic fungal infections, which can be especially important in certain populations, including patients with diabetes, patients recently treated with antibiotics, and immunosuppressed patients 6 Complications of fungal otitis externa can include:
- Tympanic membrane perforation, which can resolve with proper medical treatment but may require surgery in some cases 5
- Necrotizing otitis externa, which requires prompt medical attention 6, 3