Fungal Malignant Otitis Externa with Facial Nerve Palsy: Tissue Biopsy Aids Diagnosis

Abstract

Fungal malignant otitis externa (FMOE) is a serious and potentially life-threatening condition that is challenging to manage. Diagnosis is often delayed due to the low sensitivity of aural swabs and many antifungal drugs have significant side effects. We present a case of FMOE, where formal tissue sampling revealed the diagnosis and the patient was successfully treated with voriconazole, in addition to an up to date review of the current literature. We would recommend tissue biopsy of the external auditory canal in all patients with suspected FMOE in addition to routine microbiology swabs.

Fungal malignant otitis externa

“…Fungal infection is increasingly recognised as a cause of MOE with C. albicans and Aspergillus species the most commonly implicated micro-organisms 5 6. Fungal and bacterial culture may be negative at initial presentation3 5 with positive culture arising only later in the treatment process.…”

“…Treatment of fungal MOE requires the addition of antifungal therapy, with antibiotic medication continued initially due to the likelihood of underlying primary bacterial infection. Itraconazole, fluconazole and amphotericin B have been the preferred treatments, with voriconazole playing an increasingly important role since it became available in 2002, particularly in cases of invasive Aspergillus or resistant Candida spp 5 6. Anidulafungin is effective in cases of invasive candida infection.…”

Malignant otitis externa: An assessment of emerging pathogens and the prognostic factors

“…Malignant otitis externa (MOE) is a rapidly progressive infection of the external ear characterized by invasive inflammation of the external auditory canal, marked by necrosis of surrounding cartilage and bone tissues with tendency to extension along sub-temporal fat planes (Walton and Coulson, 2014;Lasisi and Nwaorgu, 2001). Pathologically, MOE was divided by Benecke into necrotizing otitis externa, in which only soft tissues and *Corresponding author.…”

“…Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License cartilage undergo necrosis, and skull base osteomyelitis, in which temporal or skull base bones are progressively destroyed (Benecke, 1989;Peleg et al, 2007). Pseudomonas aeruginosa is the predominant causative organism in most reports, but increasing number of reports have implicated non-pseudomonas organisms including Aspergillus fumigates and Staphylococcus aureus as the isolated causative agents (Walton and Coulson, 2014;Hobson et al, 2014). The disease is mostly seen in elderly diabetes and immunocompromised individuals, but it has also been reported in apparently healthy non-immunosuppressed individuals (Nguyen et al, 2010).…”

Malignant externa otitis: the modern principles of diagnostics and treatment

“…Грибковое поражение можно заподозрить при отсутствии положительной динамики на фоне лечения антибиотиками. К сожалению, бактериологическое исследование отделяемого из НСП не всегда позволяет получить точную информацио об этиотропном факторе ЗНО, в связи с чем ряд авторов рекомендуют обязательное дополнительное бактериологическое исследование биопсийного материала, в том числе глубоких слоев тканей [16].…”