From the Guidelines
Fungal otitis externa typically presents with pruritus and thickened otorrhea, which may be black, gray, bluish green, yellow, or white 1.
Clinical Presentations
- Pruritus: a common symptom of fungal otitis externa, often accompanied by thickened otorrhea 1
- Thickened otorrhea: may be black, gray, bluish green, yellow, or white, depending on the type of fungus involved 1
- Pain and hypoacusis: may also be present, particularly if the infection involves the middle ear 1
- Otic discharge: a common symptom of Aspergillus otomycosis, which may involve the external auditory canal and middle ear 1
Fungal Types
- Aspergillus species: commonly cause fungal otitis externa, with A. niger and A. fumigatus being the most common species involved 1
- Candida species: may also cause fungal otitis externa, resulting in white debris sprouting hyphae 1
High-Risk Patients
- Immunocompromised patients: such as those with diabetes, HIV infection, or receiving corticosteroids, are susceptible to fungal otitis externa 1
- Patients with impaired mucosal or cutaneous immunity: such as those with hypogammaglobulinemia or chronic eczema, are also at risk 1
From the Research
Clinical Presentations of Fungal Otitis Externa
The clinical presentations of fungal otitis externa can vary, but common symptoms and signs include:
- Discomfort limited to the external auditory canal 2
- Erythema and swelling of the canal with variable discharge 2
- Itchiness and impaired hearing 3
- Ear discomfort 3
Diagnosis and Treatment
Diagnosis of fungal otitis externa relies on:
- Patient's history 4
- Otoscopic examination under microscopic control 4
- Imaging studies 4
- Direct preparation of specimens, mycologic culture, and histologic examination 4 Treatment options include:
- Intense débridement and cleansing 4
- Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate 4
- Oral triazole drugs, such as itraconazole, voriconazole, and posaconazole, for malignant fungal otitis externa complicated by mastoiditis and meningitis 4
Causative Agents
The primary causative agents of fungal otitis externa are:
- Fungi of the genera Aspergillus, Candida, and Geotrichum 5
- Aspergillus and Candida spp are the most frequently isolated fungi in patients with otomycosis 4
Challenges in Management
Diagnosis and treatment of otologic fungal infections can be challenging due to: