Fungal Oto-Mastoiditis- A Rare Presentation in Immunocompetent Individuals

Fungal oto-mastoiditis is a rare condition and is often associated with host immunodeficiency. It has to be considered as a differential diagnosis among patients presenting symptoms despite an adequate antibacterial therapy. A 23-year-old female presented to the ENT OPD with complaints of occasional left ear discharge, since 2 years which was associated with itching, pain and reduced hearing. There were no complaints of swelling or pain behind the ear. Otoscopic examination revealed bulging, congested, immobile tympanic membrane in the left ear. Pure tone audiometry revealed 48.33 dB moderate mixed type of hearing loss in the left ear and tympanometry done showed type B curve in the left ear. Patient was taken up for exploratory tympanotomy where middle ear and antrum was filled with granulation tissue and peculiar looking, unusual greenish-brown debris suspicious of fungal otomycotic debris. Ossicular mobility was attained after clearing the disease from the middle ear and cortical mastoidectomy was completed. KOH study of the debris removed was positive for fungal elements as seen. Histopathological examination revealed features suggestive of Chronic suppurative otitis media. Specimen was sent for fungal culture where Aspergillus species was isolated. Patient was started on Voriconazole orally twice a day for 2 weeks. Postoperative period was uneventful and patient's hearing improved. ^® Fungal oto-mastoiditis is a rare but reported entity, which is usually seen in immunocompromised patients. A high index of suspicion is required to reach an early diagnosis and administer suitable treatment, especially when it presents in immunocompetent individuals.