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Fungal Malignant Otitis Externa: A Systematic Review
Giorgos Sideris1, Dioni-Pinelopi Petsiou1, Melina Kourklidou1
12nd ENT Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Cureus
|November 13, 2024
Summary
Fungal malignant otitis externa (FMOE) often affects immunocompromised older adults. Early antifungal treatment is crucial for improving outcomes in this serious infection.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Mycology
Background:
- Malignant otitis externa (MOE) is a severe infection, typically caused by Pseudomonas aeruginosa.
- Fungal infections can also cause MOE, particularly in immunocompromised patients.
Purpose of the Study:
- To systematically review the literature on fungal malignant otitis externa (FMOE).
- To analyze the etiology, patient demographics, clinical presentation, and treatment of FMOE.
Main Methods:
- Systematic review following PRISMA guidelines.
- Analysis of 10 studies involving 197 patients with FMOE.
- Data extraction on patient characteristics, causative fungi, and treatment outcomes.
Main Results:
- The mean age of FMOE patients was 65.9 years, with a male predominance (72.6%).
- Over 78% of patients had underlying immunosuppressive conditions.
- Candida and Aspergillus species were the most common fungal culprits; 54.3% of cases had positive fungal cultures.
- Conservative treatment with antifungals (itraconazole, voriconazole) was common (87.3%), with surgery and hyperbaric oxygen therapy used less frequently.
- The mortality rate was 4%, associated with late diagnosis and inadequate treatment.
Conclusions:
- FMOE is a serious condition predominantly affecting immunocompromised elderly individuals.
- Clinical presentation and diagnostics are similar to non-fungal MOE.
- Early empirical antifungal therapy may improve outcomes in high-risk patients, given the potential for underdiagnosis.
