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

From the Guidelines

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

Clinical Presentations

• Symptoms of fungal otitis externa include:
  • Pruritus
  • Pain
  • Hypoacusis (hearing loss)
  • Otic discharge
• The infection can involve the middle ear if the tympanic membrane is perforated, although this is more commonly a result of recurrent bacterial otitis media rather than the fungal infection itself 1.

Patient Susceptibility

• Patients with impaired mucosal or cutaneous immunity, such as those with:
  • Hypogammaglobulinemia
  • Diabetes mellitus
  • Chronic eczema
  • HIV infection
  • Those receiving corticosteroids, are more susceptible to fungal otitis externa 1.

Complications

• If left untreated, fungal otitis externa can lead to chronic fungal mastoiditis, where the infection extends into the mastoid sinus 1.
• Superinfection by opportunistic bacterial infections can occur in immunocompromised patients, especially if there is erosion and disruption of the epidermis 1.

Causative Organisms

• Aspergillus species, particularly A. niger and A. fumigatus, are the most common causes of fungal otitis externa 1.

From the Research

Clinical Presentations of Fungal Otitis Externa

The clinical presentations of fungal otitis externa 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 3, 5

Common Fungal Causes

The most common fungal causes of otitis externa are:

• Aspergillus species, including Aspergillus niger, Aspergillus flavus, and Aspergillus tubingensis 6, 4, 5
• Candida species, including Candida albicans, Candida orthopsilosis, and Candida parapsilosis 6, 5

Patient Characteristics

Fungal otitis externa can affect anyone, but it is more common in:

• Males aged 21-40 years 4
• Manual workers and students 4
• Patients with a history of trauma to the external auditory canal 4

Complications

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

• Tympanic membrane perforation 3, 5
• Necrotising otitis externa, which requires prompt medical attention 6