From the Guidelines
Fungal otitis externa typically presents with symptoms such as pruritus, pain, hypoacusis, and otic discharge.
Clinical Presentations
- Pruritus
- Pain
- Hypoacusis
- Otic discharge These symptoms are commonly seen in patients with Aspergillus otomycosis, a saprophytic process that usually involves the external auditory canal 1.
High-Risk Patients
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.
Treatment
Treatment of noninvasive Aspergillus otitis externa involves thorough mechanical cleansing of the external auditory canal followed by topical antifungals or boric acid 1.
Invasive Infections
Invasive infections, such as those seen in immunocompromised patients, may require systemic antifungal therapy, including orally administered itraconazole, voriconazole, or posaconazole 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. Some common symptoms include:
- Itching, as reported in a study published in the Turkish journal of medical sciences 2
- Unilateral, rarely bilateral, earache (otalgia) accompanied by hearing loss and sometimes discharge from the ear (otorrhea) 3
- Otalgia is one of the most common reasons for consulting a general practitioner, especially for children up to 14 years 3
- Intermittent otorrhea, occasional otalgia, and progressive unilateral hearing impairment, as seen in a case report of a 48-year-old man with fungal otitis externa associated with Aspergillus flavus 4
- Headache and pressure in the sinuses and maxilla, as reported by the same patient 4
Fungal Pathogens and Risk Factors
Fungal pathogens that can cause otitis externa include:
- Aspergillus niger, which was found to be the most common fungus causing otomycosis in a study published in 2015 2
- Aspergillus flavus, which was identified as the causative agent in a case report of a 48-year-old man with fungal otitis externa 4
- Candida species, such as Candida orthopsilosis, Candida albicans, and Candida parapsilosis, which were found to be common causes of otomycosis in a study published in 2021 5 Risk factors for fungal otitis externa include:
- Trauma to the external auditory canal, which was found to be the most common predisposing factor in a study published in 2015 2
- Diabetes, recent antibiotic treatment, and immunosuppression, which can increase the risk of fungal infections of the external auditory canal 6