Fungal Necrotizing Otitis Externa: Clinical and Therapeutic Features

Objectives: To describe the clinical and therapeutic features of fungal necrotizing otitis externa (NOE) as well as to identify the predictive factors of complications. Materials and Methods: This retrospective and monocentric study included 15 cases of fungal NOE treated in our ENT department between 2006 and 2024. Clinical, biological, microbiological, and imaging data were collected and evaluated. Results: We included 15 patients diagnosed with fungal NOE based on positive microbiological cultures. The mean age was 67.6 years. All patients had diabetes. Otalgia was the most common symptom. Complications were noted in 80% of the cases. Facial nerve palsy occurred in 5 cases (33.3%). Computed tomography imaging revealed extension to the temporomandibular joint (46.7%), middle ear involvement (60%), vascular thrombosis (26.6%), intracranial extension (13.3%), and soft tissue complications (33.3%). The identified fungi were Candida spp. (26.7%) and Aspergillus spp. (73.3%). All patients received antifungal treatment. The mean total duration (intravenous + oral) of antifungal treatment was 2 months. Clinical improvement was observed in all cases, without recurrence cases after a median follow-up of 6 months. Older age and delay before consultation were significantly associated with soft tissue extension. Immunodeficiency and delay before consultation were significantly correlated with vascular thrombosis. Conclusions: Fungal NOE is a rare but serious condition that requires prompt diagnosis and treatment. Early identification and appropriate antifungal treatment are crucial to prevent complications and achieve favorable outcomes.