Fungal Otitis Externa Research Articles

Aspergillus otitis externa: A retrospective study of predisposing factors, treatment, and complications.

To study the predisposing factors, treatment, and complications of Aspergillus otitis externa. A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed. Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty-five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis. As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves. Level 4 (The Oxford 2011 Levels of Evidence).

Single application of clotrimazole cream in the management of fungal otitis externa

Single application of clotrimazole cream in the management of fungal otitis externa

A study on mycology spectrum with aetiopathological factors and its management in otomycosis

Background: Otomycosis (fungal otitis externa), is a fungal infection of external auditory canal (EAC). It is a common challenging problem in the ENT clinic, because for the need for long term treatment and follow up. The present study was thus designed with the view to know the mycological pattern encountered in otomycosis along with the aetio-pathological factors and its management. Methodology: A prospective study was done in the Department of ENT, Sri Siddhartha Medical College & Hospital, Tumkur for a period of 12 months, total of 51 patients of both genders with clinical features of otomycosis were enrolled in the study. 2 swabs were taken from the EAC of all cases and after aural toileting under microscope, were treated with 1%clotrimazole and followed up for 2 months Results: A total of 51 patients were examined in this study, of which 47 cases produced positive fungal isolates (92.1%). Females were more commonly affected than males. Most common pre-disposing factor was manipulation of the ear by unsterile material for cleaning the ear. Itching and pain were the most common symptoms, Aspergillus was the most common fungus isolated. Clotrimazole showed good response symptomatically and mycological clearance was seen within a week. Conclusion: Otomycosis is still a common problem and is often misdiagnosed for other chronic otitic conditions. Fungi thrive on exfoliated dead epithelial cells along with humid environment in EAC. Thorough cleaning of fungi followed by topical antifungal agent is important in management of this condition. Clotrimazole is effective, safe and well tolerated topical antifungal agent.

Fungal otitis externa and tympanic membrane perforation.

Otomycosis is a fungus-causing superficial infection of the external auditory canal that is common in otolaryngology practice. Though it is a worldwide infection, but is more prevalent in warm and humid regions. There has been rise in the occurrence of otomycosis in the last few years because of the extensive usage of antibiotic eardrops. Other influencing reasons for the occurrence of otomycosis is swimming, an immunocompromised host (e.g.: DM, AIDs) pregnancy, post-canal wall down mastoidectomy, tympanic membrane perforation, hearing aids and self-inflicted injuries. Approval from the institutional ethics committee and penned informed agreement from all patients involved in the examination were obtained. 40 patients were included in the study, starting from 1stAugust to 30th September 2021, which emphasized on otomycosis infection with central tympanic membrane perforation. Physical findings such as whitish ear discharge and the presence of hyphae in the EAC, the ear drum, the middle ear mucosa were used to diagnose otomycosis. 20 patients of patched group and 20 patients of non-patched group did not visit for follow up. Data here is for patients who followed-up for 3 weeks. Any significant observation regarding statistical variation in the age, size of perforation, mycological analysis and pure tone audiometry among the two groups were not seen. To conclude, we state that treatment with clotrimazole solution in patched group is safe in managing otomycosis with tympanic membrane perforation. Otomycosis is a fungus causing surface infection of the external auditory canal that otolaryngologists routinely diagnose by medical examination. In acute otomycosis, overgrowth of the fungus in the external auditory canal is due to increased humidity.

990. Fungal Malignant Otitis Externa: Clinical and Therapeutic Features

Abstract Background Fungal malignant otitis externa is a rare, but a serious infection that might lead to death if not promptly diagnosed and treated. We aimed to study the clinical, therapeutic and evolutionary features of fungal malignant otitis externa. Methods We conducted a retrospective study including all cases of fungal malignant otitis externa hospitalized in the infectious diseases department between 2003 and 2020. Results We included 35 patients with a mean age of 68±11 years. There were 18 males (51.4%). All patients were diabetics, and 7 patients had a previous medical history of otitis externa (20%). The use of topical corticosteroids was noted in 10 cases (28.5%). The revealing symptoms were otalgia (97.1%), otorrhea (82.9%) and cephalalgia (54.3%). Physical examination revealed tenderness to palpation of the mastoid bone in 21 cases (60%) and the temporomandibular joint in 16 cases (45.7%). Facial paralysis was noted in 14.3% of the cases. Otoscopic examination revealed stenosis of the external auditory canal (94.3%), granulation tissue (34.3%) and a polyp (31.4%). Candida species were isolated in 22 cases (62.8%) represented by Candida parapsilosis in 15 cases (42.8%) and Candida albicans in 5 cases (14.2%). Serological tests detecting Candida were positive in 12 cases (34.2%). Aspergillus species were isolated in 13 cases (37.1%) represented mainly by Aspergillus flavus in 7 cases (20%). Positive serology results for Aspergillus were noted in 8 cases (22.8%). A polyp or granulation tissue biopsy, performed in 12 cases (34.2%), revealed non-specific inflammatory reaction (28.5%) and the presence of fungal hyphae and spores (5.7%). After empirical antibiotics treatment, patients received fluconazole in 18 cases (51.4%) and voriconazole in 17 cases (48.6%). The median duration of treatment was 3 [1.5-12] months. Both surgery and hyperbaric oxygen therapy were indicated in one case (2.8%). Complications including the onset of contralateral otitis (14.3%) and endocranial extension (8.6%) were noted. The disease evolution was favorable in 65.7% of the cases. Four patients were dead (11.4%). Conclusion Involvement of fungal species in malignant otitis externa should be considered in front of the absence of improvement with antibiotic. Prompt treatment might prevent complications. Disclosures All Authors: No reported disclosures

Fungal otitis externa and tympanic membrane perforation: four-year experience at a Victorian hospital

Background: It is estimated that 9% of all otitis externa is due to fungal pathogens. A recent literature review revealed only 10 case series reporting on fungal otitis externa (FOE) and tympanic membrane perforation (TMP) with few reporting the rates of persistent TMP. Therefore, we aim to investigate patients with FOE and TMP over a four-year period.

Direct Detection and Identification of the Most Common Bacteria and Fungi Causing Otitis Externa by a Stepwise Multiplex PCR.

BackgroundConsidering the importance of differential diagnosis of infectious otitis externa (OE), a stepwise PCR-based assay using universal and genus- or species-specific primers for the detection/identification of the most prevalent bacterial and fungal OE was developed and evaluated on the ear aspiration specimens of clinically suspected patients.Methods and MaterialsA total of 120 ear aspiration specimens with otomycosis suspicion were subjected to manual DNA extraction using phenol–chloroform extraction after tissue digestion with a lysis buffer. The multiplex PCR was initially performed using pan-fungal and bacterial homemade primers. Pseudomonas and Staphylococcus specific primers were simultaneously used in one reaction mixture to identify the bacterial genera. Furthermore, for the identification of fungal agents, Candida species-specific multiplex primers targeting the most clinically important Candida species causing OE (i.e., C. albicans, C. parapsilosis, and C. auris), as well as Aspergillus related multiplex PCR identifying the most prevalent Aspergillus species were used in two separate reaction mixtures. All the results of multiplex PCR were interpreted based on the amplicon size.ResultsThe overall multiplex PCR-based detection rate of bacterial (n = 88; 73.3%) and fungal (n = 97; 81%) OE was documented to be 100% along with and complete consistency with the results of direct examination and Giemsa staining. Double amplicon bands of bacterial and fungal pathogens were evidenced in 76 specimens (63.3%). Moreover, the positivity rate of pan-fungal PCR was higher than that of the culture result. Out of 88 pan-bacterial positive PCR specimens, 66 and 47 ones were positive for Staphylococcus and Pseudomonas, respectively. In addition, 30 samples exhibited mixed infection of both, and five specimens remained negative. Out of 97 pan-fungal positive PCR specimens, 67 and 51 ones contained Candida and Aspergillus species, respectively. It should be noted that dual amplicon bands of Candida and Aspergillus-related multiplex PCR were yielded in 30 specimens.ConclusionThe stepwise multiplex PCR assay proved to be more sensitive, more rapid, as well as less cumbersome in detection and identification of fungal and bacterial OE, compared to culture.

Molecular Identification and Antifungal Susceptibility of Yeasts and Molds Isolated from Patients with Otomycosis.

Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10-20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.

651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

BackgroundMalignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa.MethodsWe conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018.ResultsOverall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03).ConclusionOur study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment.Disclosures All Authors: No reported disclosures

Estimated Burden of Fungal Infections in Oman.

For many years, fungi have emerged as significant and frequent opportunistic pathogens and nosocomial infections in many different populations at risk. Fungal infections include disease that varies from superficial to disseminated infections which are often fatal. No fungal disease is reportable in Oman. Many cases are admitted with underlying pathology, and fungal infection is often not documented. The burden of fungal infections in Oman is still unknown. Using disease frequencies from heterogeneous and robust data sources, we provide an estimation of the incidence and prevalence of Oman’s fungal diseases. An estimated 79,520 people in Oman are affected by a serious fungal infection each year, 1.7% of the population, not including fungal skin infections, chronic fungal rhinosinusitis or otitis externa. These figures are dominated by vaginal candidiasis, followed by allergic respiratory disease (fungal asthma). An estimated 244 patients develop invasive aspergillosis and at least 230 candidemia annually (5.4 and 5.0 per 100,000). Only culture and microscopy are currently available for diagnosis, so case detection is suboptimal. Uncertainty surrounds these figures that trigger the need for urgent local epidemiological studies with more sensitive diagnostics.

Fungal otitis externa in children: principles of diagnosis and rational therapy

To study the current diagnosis and treatment of fungal inflammation of the external auditory canal in children. This article summarizes the literature on predisposing factors for the occurrence of fungal infections of the external auditory canal in children. In this study, we present modern approaches to the diagnosis and treatment of external fungal otitis media in children depending on the isolated genus and species of fungus. We established that, according to the study conducted from 2015 to 2017 in the L.I. Sverzhevskiy Clinical Research Institute of Otorhinolaryngology, the incidence of the external fungal otitis media in children is 13,0%. The primary causative agents of fungal inflammation are fungi of the genera Aspergillus, Candida and Geotrichum. In the presented study, the rationale for the selected treatment regimen was made based on data obtained during microbiological studies.

Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial

IntroductionOtomycosis, an infection of the ear canal by fungi, is prevalent in hot and humid weather. Nevertheless, there is not sufficient evidence for the effectiveness of different topical antifungal treatments. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Currently there are not sufficient studies that prove its efficacy. ObjectivesTo compare the efficacy of clotrimazole and tolnaftate administration in the treatment of otomycosis. Material and methodsA controlled, randomized and open clinical trial included patients diagnosed with fungal external otitis who were treated with topical antifungals, randomized into two treatment groups: (1) clotrimazole cream; (2) tolnaftate solution. They were microscopically evaluated at one and two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed. Follow-up and final outcomes (absence of infection) were compared between groups. ResultsForty eight patients were included, 28 in the clotrimazole group and 20 in the tolnaftate group. Spring was the weather most commonly associated with otomycosis, while otic manipulation was the risk factor more common in both groups. Predominant symptoms were itching and otic fullness. Aspergillus niger organism was isolated most frequently. Treatment with clotrimazole resulted in 75% resolution vs 45% resolution with treatment with tolnaftate at one week of treatment (p=0.007). The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures, 20% and 15% respectively. ConclusionsClotrimazole cream treatment is more effective than tolnaftate for uncomplicated otomycosis. More studies are needed to corroborate our results.

Malignant otitis externa in Australian Aboriginal patients: A 9-year retrospective analysis from the Northern Territory.

In the Australian Aboriginal population, type 2 diabetes occurs at a much higher prevalence, with a much younger age of onset of the disease and its complications. Despite the clear association with malignant otitis externa, no previous studies have examined malignant otitis externa in this population. This study explores the pattern of malignant otitis externa amongst Australian Aboriginal patients in the Northern Territory. Retrospective case series. Otolaryngology unit in a tertiary referral hospital in Northern Territory, Australia. Patients admitted with malignant otitis externa between January 2007 and October 2016 were identified by reviewing case notes. Patients diagnosed with malignant otitis externa based on results from clinical, microbiological and radiological criteria were included. Complications rates, duration of hospital stay and parenteral antibiotics, age of onset and causative organisms. Nine patients were included. Six were Australian Aboriginal - all from regional centres. The most common causative organism was Pseudomonas aeruginosa. There was a higher-than-expected occurrence of fungal malignant otitis externa (33% of Australian Aboriginal patients), who tended to be younger at diagnosis, had longer hospital stays and had a higher disease-specific mortality. Over half of the patients did not receive follow-up gallium bone scans to monitor disease resolution, reflecting the limitations of rural health care. Malignant otitis externa in the Australian Aboriginal population is a challenging disease with high complication and mortality rates. Their rural and remote distribution is a significant barrier to specialist investigation and care. Providing effective care for this disease requires improved access to high-quality primary health care and tertiary specialist services.

AB091. 239. Treatment of otomycosis: a review

Background: The incidence of fungal otitis externa in western Europe, has increased over the past number of decades. Clinically, it presents in a similar fashion to other pathologies, therefore, it can be often be misdiagnosed and treated inappropriately. Aspergillus and Candida are shown to be the commonest causative species isolated in fungal otitis externa. Otomycosis is commonly diagnosed post antimicrobial therapy with no resolution. To date, there is no gold standard approach in place for the treatment of otomycosis. Several studies have shown the efficacy of topical drying agents, anti-inflammatories, antifungals, and combination powders as part of a multi-modal approach. To identify the different approaches and modalities used for the eradication of fungal otitis externa.

A randomized placebo-controlled trial of the efficacy and safety of a terbinafine, florfenicol and betamethasone topical ear formulation in dogs for the treatment of bacterial and/or fungal otitis externa

BackgroundTreatment of infected otitis externa (OE) relies on the topical application of specific formulations that most often contain an antibiotic, an antifungal and a glucocorticoid. This study is to report the results of a randomized, placebo-controlled field trial evaluating the efficacy and safety of OSURNIA™ (Elanco Animal Health, a division of Eli Lilly and Company, Greenfield, IN), a novel topical ear medication containing florfenicol, terbinafine and betamethasone acetate in an adaptable gel. The study includes 284 dogs with bacterial and/or fungal OE who were randomly assigned to receive two doses of Osurnia or its vehicle, one week apart. Dogs were evaluated at various time points through Day 45, and a total clinical score (TCS) was calculated based on pain, erythema, exudate, swelling, odor and ulceration. The primary outcome measure was the rate of treatment success (RTS), defined as a TCS of 0, 1 or 2 on Day 45. Before and after treatment, a “clap test” was performed to subjectively assess hearing, and blood and urine were collected for routine clinical pathology.ResultsThe RTS was significantly higher in ears treated with Osurnia (64.78%) than with placebo (43.42%). There was no significant interaction between efficacy and duration of history, recurrence of otitis or body weight. Adverse events were similar between groups. All dogs treated with Osurnia maintained their hearing, and there were no relevant clinical pathology changes.ConclusionsThe application of two doses of Osurnia, one week apart, is effective and safe to treat microbial otitis externa in dogs.

Analysis of the otic mycobiota in dogs with otitis externa compared to healthy individuals

Otitis externa is a common multifactorial disease with a prevalence in dogs as high as 10-20%. In humans, the diversity of the cutaneous mycobiota appears to increase in diseased states, whereas one canine study identified a decrease in diversity of the cutaneous mycobiota in atopic dogs compared to healthy individuals. To describe the otic mycobiota in dogs with otitis externa compared to healthy dogs. Samples were collected from six dogs with clinical and cytological evidence of otitis externa and five clinically normal dogs. Swabs were collected from the ears of six dogs with fungal otitis externa. DNA from each sample was isolated and Illumina sequencing was performed targeting the internal transcribed spacer region. Sequences were processed using the bioinformatics software MOTHUR. Fungi from ten different phyla were identified. The mycobiota of all affected ears was dominated by the genera Malassezia, which accounted for 55.7-98.4% of sequences (median 96.8%). Affected ears had significantly decreased observed richness, estimated richness and inverse Simpson's diversity index compared to controls (P = 0.008). Linear discriminant analysis effect size (LEfSe) analysis identified 42 operational taxonomic units (OTUs) that were differentially abundant (P < 0.05). Three OTUs were over-represented in the affected ears, including M. pachydermatis, whereas 39 OTUs were over-represented in healthy ears. Reduced fungal richness and diversity was present in affected ears, with markedly higher relative abundances of Malassezia. The otic fungal mycobiota is much more complex than has been identified with culture-based studies.

악관절에서의 조직 검사로 원인균이 확인된 진균성 악성외이도염 1예

악관절에서의 조직 검사로 원인균이 확인된 진균성 악성외이도염 1예

Fungal Otitis Externa: Clinical and Fungal Evaluation in HyderabadKarnataka Region

Fungal Otitis Externa: Clinical and Fungal Evaluation in HyderabadKarnataka Region

Otomycosis: the modern view of etiology and management

This article deals with the modern approaches to the diagnostics and treatment of fungal ear infection depending on the localization of the inflammatory process and the species of the causative fungal agent with special reference to the factors underlying the development of otomycosis under the present-day conditions based on the results of the analysis of the studies carried out during the period from 2010 to 2014. The materials of the examination of 2152 patients who applied for the medical care to various clinical departments of the Institute and were found to present with chronic inflammatory ear pathology were available for the analysis. Fungal lesions were diagnosed in 495 (23%) patients with this condition. Fungal lesions of the external ear were the predominant form of pathology; they were documented in 331 (67%) patients. Fungal otitis media was diagnosed in 85 (17%) patients and fungal lesions of the postoperative cavity in 79 (16%) patients suffering from otomycosis. 65% of the patients presenting with external fungal otitis, 20% of those with fungal otitis media, and 95% of the patients with inflammation of the postoperative cavity were infected with mold fungi dominated by the genus Aspergillus spp. 79 (16%) patients suffering from otomycosis. In 35% of the patients presenting with fungal external otitis, 80% of those with fungal otitis media, and 5% of the patients with inflammation of the postoperative cavity of the middle ear, the causative agents of the disease were the fungi Candida spp. The authors describe the modern schemes for the treatment of otomycosis elaborated at the L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology.

Evaluation of a single-administration ototopical treatment for canine otitis externa: a randomised trial

ObjectiveTo evaluate the efficacy and safety of a new, single-administration Otic Solution containing florfenicol, terbinafine and mometasone furoate for the treatment of canine otitis externa (OE).DesignThe clinical efficacy and safety...