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Fungal otitis externa as a cause of tympanic membrane perforation: a case series

James Eingun Song1, Thomas J Haberkamp, Riddhi Patel

  • 1Department of Dermatology, University of California, Irvine, 118 Med Surge I, Irvine, CA 92697, USA. Esong812@gmail.com.

Ear, Nose, & Throat Journal
|September 3, 2014
PubMed

Insights

Fungal otitis externa with tympanic membrane perforation often presents with vague symptoms, complicating diagnosis. However, thorough ear cleaning and antifungal treatment effectively resolve most cases, often healing the perforation without surgery.

Area of Science:

  • Otolaryngology
  • Mycology
  • Infectious Diseases

Background:

  • Fungal otitis externa (FOE) can present with nonspecific symptoms, leading to diagnostic challenges.
  • Complicated FOE involving tympanic membrane perforation (TMP) requires specific management strategies.
  • Chronic, treatment-refractory ear conditions may indicate underlying FOE with TMP.

Purpose of the Study:

  • To evaluate the clinical presentation and treatment outcomes of fungal otitis externa complicated by tympanic membrane perforation.
  • To assess the efficacy of conservative management including debridement and antifungal therapy for FOE with TMP.
  • To determine the necessity of surgical intervention for TMP secondary to fungal infections.

Main Methods:

  • Retrospective case series of 11 patients with fungal otitis externa and TMP.
  • Patients received thorough ear debridement and one of two antifungal medication regimens.
  • Outcomes including symptom resolution and TMP closure were documented.

Main Results:

  • Eight out of 11 patients achieved complete resolution of symptoms and TMP closure.
  • Three patients required surgical intervention (tympanoplasty or fat-graft myringotomy) for persistent perforation.
  • Diagnosis of FOE was challenging for referring physicians due to nonspecific symptoms.

Conclusions:

  • Fungal otitis externa with tympanic membrane perforation can be effectively treated with conservative measures like debridement and antifungal therapy.
  • Most tympanic membrane perforations secondary to fungal otitis externa resolve with medical management, minimizing the need for surgery.
  • Increased physician awareness is needed to diagnose fungal otitis externa presenting with chronic, refractory symptoms.

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