Clinical presentation of aspergillus and candida in otomycosis: A cross-sectional study at a tertiary hospital in Central Java, Indonesia.

Abstract

Introduction: Otomycosis is a common fungal infection of the external auditory canal, particularly in tropical regions. Aspergillus and Candida are the main causative agents, yet their clinical differentiation remains challenging due to overlapping manifestations. This study aimed to identify the distribution of fungal etiologies, and to compare clinical manifestations and predisposing factors between Aspergillus and Candida infections in a tertiary hospital in Central Java, Indonesia.

Materials and methods: A cross-sectional study was conducted at a tertiary hospital, including patients aged 17 years and above with clinically and microbiologically confirmed otomycosis. Demographic data, symptoms, physical findings, and predisposing factors were collected. Fungal identification was performed using culture and microscopy. Comparative analyses were conducted using chi-square or Fisher's exact test.

Results: A total of 41 patients (56 fungal isolates) were included. Aspergillus spp. accounted for 58.9% of isolates, while Candida spp. comprised 41.1%, with mixed infections observed in 16.1%. Itching, hearing loss, and ear fullness were the most common symptoms in both groups. No statistically significant differences were found in clinical manifestations or physical examination findings between Aspergillus and Candida infections (all p>0.05). Although whitish debris was more frequent in Candida and brownish debris in Aspergillus, these patterns were not discriminatory. Ear drop use and cotton bud manipulation were significantly associated with Aspergillus infections (p<0.05).

Conclusion: Substantial clinical overlap exists between Aspergillus and Candida otomycosis, underscoring the importance of microbiological confirmation for accurate diagnosis.