Otomycosis is a fungal infection of the external ear; middle ear and open mastoid cavity.
External ear canal has an ideal warm humid environment for the proliferation of fungus. Recurrence rate is high in immunocompromised patients and they need longer duration treatment and complications are more frequent in immunocompromised patients.
In the recent years; opportunistic fungal infections are gaining greater importance in human medicine as a result of possibly huge number of immunocompromised patients. Hematological investigations play a very important role in confirming the diagnosis and immunity status of the patients.
In diabetic patients with otomycosis, along with antifungal therapy, blood sugar levels should be controlled with medical therapy Fungus ear infection prevent complications. Otomycosis or fungal otitis externa has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear.
In the past, there were controversies regarding the prevalence and even existence of otomycosis. It is now considered to be a definitive clinical entity and a continuing problem. General cellular immunity is reduced in situations such as diabetes, steroid administration, HIV infection, chemothraphy and malignancy especially those involving cells of immune system.
This makes an immunocompromised host susceptible to fungal infections. Normal bacterial flora is one of the host defense mechanism against fungal infections.
This mechanism is altered in patient patients using antibiotics ear drops and cause otomycosis. Otomycosis is sporadic and caused by a wide variety of fungi, most of which are saprobe occurring in diverse type of environmental material.
This is desiccated rapidly in tropical sun and blown in wind as small dust particles. Higher incidence in young adults may be attributed to the fact that these people are more exposed to the mycelia, whereas extreme age groups are not exposed to the pathogens.
Common symptoms of otomycosis are itching, ear pain, ear discharge, blocking decreased hearing and tinnitus. A few conditions may predispose an individual for otomycosis table 1. Patients suffering from diabetes, lymphoma, transplantation patients, patient receiving chemotherapy or radiation therapy and AIDS Fungus ear infection, are also at increased risk for potential complications from otomycosis 9.
Ear cleaning habits may also contribute to pathogenesis. Traumatized external ear Fungus ear infection skin can present a favorable condition for fungal growth.
Among the fungi, the species of Aspergillus are considered the predominant organisms implicated in the etiology of otomycosis in tropical countries. Infection with Candida can be more difficult to detect clinically because of its lack of characteristic appearance like Aspergillus and can present as otorrhea not responding Fungus ear infection aural antimicrobials. Otomycosis attributed to Candida is often identified by cultural data.
Pseudallescheria boydii is a saprophytic fungus capable of causing invasive fungal infections in humans, especially in immunocompetent hosts. This Fungus ear infection is morphologically similar to Aspergillus but is resistant to conventional systemic antifungal therapy with Fungus ear infection B. Many studies have shown that otomycosis is predominantly unilateral disease in immunocompetent hosts. Fungal cultures are essential to confirm the diagnosis. In diabetic patients with otomycosis, blood sugar levels should be controlled with medical therapy to prevent complications due to otomycosis.
All the relevant hematological investigations should be done in immunocompromised Fungus ear infection. Complications of otomycosis includes tympanic membrane perforation, hearing loss and invasive temporal bone infection table 2. Tympanic membrane perforation is seen more commonly in immunocompromised patients than in immunocompetent patients. Most of the perforations were behind the handle of the malleus. The mechanism of perforation has been attributed to mycotic thrombosis of the tympanic membrane blood vessels resulting in avascular necrosis of tympanic membrane.
Tympanic membrane involvement is likely a consequence of fungal inoculation in the most medial aspect of the external canal or direct extension of the disease from adjacent skin. In immunocompromised patients malignant otitis externa can, rarely, present as an aggressive angioinvasive fungal infection of the temporal bone. Invasive Aspergillosis is most commonly observed in patients with lymphoproliferative disorders, but it may occur in variety of diseases characterized by defective humoral or cell-mediated immunity.
Haruna et al 19 reported a case of invasive fungal temporal bone infection caused by Mucor, leading to meningoencephalitis in an immunocompromised patient.
Nicolas et al 14 Fungus ear infection reported a case of invasive Pseudallescheria boydii fungal infection of the temporal bone in a patent with AIDS. Treatment of otomycosis includes microscopic suction clearance of fungal mass, discontinuation of topical antibiotics and treatment with antifungal ear drops for three weeks.
Ear should be kept dry for three weeks. Small perforations heal spontaneously and larger perforation requires myringoplasty. Bassouni et al 21 studied the effects of antifungal agents and found that clotrimazole ear drops was Fungus ear infection effective antifungal agent in the treatment of otomycosis.
According to Stern et al 22 and Jackman et al, 23 clotrimazole ear drops is the most effective antifungal agent. In another study fluconozole ear drops was found to be more effective in treating otomycosis. Oral and intravenous preparations of antifungal agents are available for severe infections in immunocompromised patients.
Fungal infections of the mastoid cavity of the immunocompromised patients who have undergone canal wall down mastoidectomy are seen quite frequently and they require prolonged treatment with antifungal ear drops and oral antifungal drugs.
The Fungus ear infection treatment for patients suffering from fungal otomastoiditis includes surgical debridement and systemic Fungus ear infection therapy with amphotericin B being the gold standard. Diagnosis and management of otomycosis in can be really challenging in immunocompromised patients. Recurrences are common in immunocompromised patients than in immunocompetent patients. Eradication the disease may be difficult in immunocompromised patients, who have undergone canal wall down mastoidectomy.
In these patient prolonged antifungal therapy is required. Otologist should remain alert for otomycosis and should consider obtaining hematological investigations and fungal cultures when this disease is suspected in immunocompromised host. The authors have declared that no competing interests exist.
National Center for Biotechnology InformationU. Mediterr J Hematol Infect Dis.
Published online Jan Borlingegowda Viswanatha 1 and Khaja Naseeruddin 2. Author information Article notes Copyright and License information Disclaimer. Received Nov 9; Accepted Dec This article has been cited by other articles in PMC. Abstract Otomycosis is a fungal infection of the external ear; middle Fungus ear infection and open mastoid cavity. Introduction Otomycosis or fungal otitis externa has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear.
Table 1 Showing predisposing factors for otomycosis. Open in a separate window.
Alteration in the anatomy by canal wall down procedures may also produce changes in the Fungus ear infection production or relative humidity that favor fungal growth. Table 2 Showing complications of otomycosis. Conclusion Diagnosis and management of otomycosis in can be really challenging in immunocompromised patients. Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan university teaching hospital, Kathmandu, Nepal.
Ann Otol Rhinol Laryngol. Fungal infections of the head and neck: Otolaryngol Cli N Am.