Fungal Necrotizing Otitis Externa: Clinical and Therapeutic Features.

Area of Science:

• Otolaryngology
• Infectious Diseases
• Mycology

Background:

• Necrotizing otitis externa (NOE) is a severe infection of the external auditory canal.
• Fungal etiology is less common but associated with significant morbidity, especially in immunocompromised individuals.

Purpose of the Study:

• To characterize clinical and therapeutic aspects of fungal NOE.
• To identify predictors of complications in fungal NOE.

Main Methods:

• Retrospective, monocentric study of 15 fungal NOE cases (2006-2024).
• Inclusion of clinical, biological, microbiological, and imaging data.
• Evaluation of antifungal treatment and outcomes.

Main Results:

• All 15 patients had diabetes; mean age was 67.6 years.
• Common symptoms included otalgia; 80% experienced complications, including facial nerve palsy (33.3%).
• Imaging revealed extensive involvement (middle ear, TMJ, intracranial); Aspergillus spp. (73.3%) predominated. All improved with 2-month antifungal therapy.

Conclusions:

• Fungal NOE is rare, serious, and requires timely diagnosis and treatment.
• Early antifungal intervention is key to preventing complications and ensuring favorable outcomes.
• Older age, delayed consultation, and immunodeficiency are associated with increased complication risk.