Fungal otitis externa and tympanic membrane perforation: four-year experience at a Victorian hospital

Abstract

Background: It is estimated that 9% of all otitis externa is due to fungal pathogens. A recent literature review revealed only 10 case series reporting on fungal otitis externa (FOE) and tympanic membrane perforation (TMP) with few reporting the rates of persistent TMP. Therefore, we aim to investigate patients with FOE and TMP over a four-year period. Methods: A retrospective chart review was performed on patients presenting to a specialty ear, nose, and throat emergency department with FOE and TMP between June 2015 to October 2019. Diagnosis of FOE was accepted based on positive swab culture or documented fungal spores on examination. Data collection included patient demographics, perforation details, treatment, follow up, persistent TMP, recurrence of FOE with or without TMP. Statistical analysis was performed using JASP 0.11.1. Results: A total of 87 patients were identified, corresponding to 93 ears. In 58 (62.4%) ears, a swab was taken, with Aspergillus niger identified as the most common pathogen. Fungal spores were noted in 66 (71%) ears. In 59 (63.4%) ears, more than one topical agent was required to achieve resolution of infection. Persistent TMP was noted in 19 (28.4%) ears with an acute TMP and in 22 (84.6%) ears with a possible chronic TMP. Forty ears (43%) had recurrence of FOE. Three (3.2%) ears had recurrent TMP. Conclusions: FOE with co-existing acute or chronic TMP remains a difficult condition to treat with most ears requiring multiple topical agents and there is a high rate of recurrence of FOE. Persistent TMP remains a common complication of FOE with acute TMP.