Otomycosis
Otomycosis is an ear disease that provokes the appearance of fungal flora. The fungus can cause inflammation of the middle and outer ear, as well as affect the cavity of the mastoid process after surgery (mastoidotomy). Otomycosis does not have pronounced specific symptoms. This disease has a whole set of symptoms that can be not only its signs (pain, hearing loss, congestion in the ear, abundant discharge from the external auditory canal). This diagnosis can be obtained based on bacterial culture data taken from the ear (using a microscopic examination method). But initially, the doctor examines the patient by conventional otoscopy.
The content of the article:
Classification of otomycosis
Causes of otomycosis
Symptoms of otomycosis
Diagnosis of otomycosis
Physical diagnostics
Laboratory diagnostics
Treatment and prognosis of otomycosis
Otomycosis
Classification of otomycosis
The classification of otomycosis directly depends on the localization of the inflammatory process. There are four main forms: fungal otitis media, external fungal otitis, fungal myringitis and fungal postoperative otitis media. The most common is external otomycosis. The clinical course of otomycosis has three stages: the initial stage is characterized by a subjective feeling of ear congestion, itching, sometimes without visualized changes. All signs of an acute inflammatory process (pain, redness, swelling, the release of copious discharge from the ear) are characteristic of the acute stage of fungal lesions. The chronic stage of otomycosis is characterized by less pronounced symptoms of inflammation, this stage is characterized by a sluggish and prolonged course, with periods of remission and repeated exacerbations, at the time of which pain in the ear and discharge from the external auditory canal reappear.
Causes of otomycosis
The etiological factor of otomycosis is clear from the first lines of this article, the causative agents of this ailment are fungi, in particular of the mold genus: Rnizopus, Penicillium, Aspergillus and yeast—like fungi, of the genus Candida, they get into the ear and provoke inflammation. The causes of otomycosis can be transferred dermatitis of the skin of the external auditory canal, chronic purulent otitis media, eczematous diseases and microtrauma of the external auditory canal. After the use of antibiotic therapy during the treatment of any disease, the appearance of fungi can also be provoked, for the reason that antibacterial drugs act on the normal flora in the body and can lead to dysbiosis, which only contributes to the reproduction of fungi. Predisposing factors to the appearance of otomycosis can be called metabolic disorders, general and local allergic reactions, changes in the neurohormonal state and carbohydrate metabolism, various dysfunctions of the sebaceous glands. Sometimes otomycosis is provoked by the peculiarities of working conditions, cloakroom attendants, receivers of old things, salvage collectors and other harmful work fall into the risk group.
In addition to the above factors, there are many other favorable moments that provoke the vital activity of fungi, among them there is good access of atmospheric air, which gives carbon dioxide and oxygen necessary for the nutrition of fungi, high humidity, lack or absence of direct sunlight, preventing the development of fungi. Anatomical and physiological features of the external auditory canal make it possible for fungi to comfortably exist in a place protected from any stimuli. In such conditions, fungi develop, form dense plexuses of mycelium and provoke inflammation of the skin.
Symptoms of otomycosis
The first sign of external otomycosis is usually the disappearance of the fatty film that covers the skin of the external auditory canal, this may be due to chronic microtrauma of the skin and increased humidity. At this point, swelling of the auditory canal may appear, as a result of blockage of the sebaceous glands in his skin. This stage is characterized by patient complaints of congestion and pain in the ear. Often, when such symptoms appear, patients believe that they have formed a sulfur plug or clogged the external auditory canal. Attempts at self-treatment lead to damage to the integrity of the skin of the auditory canal and contribute to the penetration of a fungal infection into it.
The acute stage of otomycosis is accompanied by a more abundant discharge of the discharge from the ear. The contents of the discharge may contain mycelium of fungi and epithelial cells. Sometimes the lumen of the auditory canal is completely blocked due to swelling, such a process is accompanied by pronounced hearing loss and noise in the ear, as a consequence of a violation of the sound-conducting function of the auditory canal. During the acute stage, otomycosis is accompanied by a pronounced pain syndrome, which increases at the time of swallowing movements.
In most cases, otomycosis is limited to the lesion of the skin of the external auditory canal, but sometimes inflammatory processes spread to the middle ear cavity, such complications are characteristic of people with diabetes mellitus and leukemia.
Against the background of already developed inflammation of the tympanic membrane — chronic purulent otitis media, sometimes mycotic otitis media appears. The clinical signs of this disease are a sharp deterioration in the general condition of the patient, all previous symptoms are aggravated (copious discharge from the ear, pain, ear congestion), plus periodic headaches are added to this.
After the fungal lesion spreads to the eardrum from the skin of the auditory canal, fungal myrigitis occurs. During fungal myringitis, the mobility of the eardrum decreases, which contributes to hearing loss.
Patients who underwent radical mastoidectomy (removal of mastoid process cells) are at risk of developing postoperative otomycosis.
Diagnosis of otomycosis
Diagnosis of otomycosis includes several stages. The main component of the diagnosis of this disease is the identification of characteristic complaints (interview of the patient), the study of the patient’s anamnesis, examination of the patient using otoscopy or microscopy, microscopic examination of the discharge from the ear after taking a smear, bacteriological crops of the discharge on nutrient media to detect the presence of fungal bacteria for their specific and generic identification.
At the time of the survey, it is important to pay attention to the features of the course and the time of the onset of the disease. It is also necessary to clarify with the patient whether there has been any previous otomycosis or fungal lesions of other organs, the nature of exacerbations, their frequency and duration.
It is necessary to collect data on previous treatment (local or general), on its effectiveness and the presence of exacerbations. It is important to clarify whether the patient has used antibiotic therapy, cytostatic drugs (intensity and duration of treatment), glucocorticoids, peculiarities of working conditions, living conditions, the presence of allergic reactions in the past, as well as past illnesses. In patients who have previously been diagnosed with otomycosis, the frequency of exacerbations, the presence or absence of the effect of standard treatment are taken into account.
Physical diagnostics
When affected by penicillin fungi, the process is usually localized in the external auditory canal. During a physical examination, a slight infiltration of the skin of the outer part of the auditory canal is noted, which does not lead to a complete closure of its lumen. Hyperemia of the eardrum is visualized, sometimes it partially protrudes, which creates false ideas about its perforation.
In some cases, the differentiation of otomycosis in penicilli lesions is difficult for the reason that the pathological discharge has various shades of gray and is very similar to earwax, in some cases dry crusts or films appear. Such “pseudo-sulfur crusts” cover almost the entire surface of the auditory canal.
In the case of aspergillosis otomycosis, the auditory canal also narrows as a result of infiltration of its skin, but the infiltration is more pronounced in the bone department. Almost all cases of this type of otomycosis are associated with infiltration of the tympanic membrane. Sometimes granulation is noted. The pathological discharge in aspergilleous otomycosis is abundant and differs in color from penicilli. Usually it is gray in shades and has black dots in the admixture, it may resemble a soaked newspaper.
The candidiasis lesion of the auditory canal is characterized by moderate infiltration, more pronounced in the cartilaginous region, with otoscopy, the tympanic membrane has a hyperemic surface. The pathological discharge has a curd consistency of white color and it is more liquid in comparison with other otomycoses. The process often spreads to the skin of the outer ear.
Laboratory diagnostics
After a physical examination, it is already possible to diagnose “otomycosis”, but it will remain questionable until microscopic laboratory tests are carried out. In some cases, the results of a single such analysis may not show the presence of a fungal lesion, then it is worth retesting the pathological discharge.
To obtain samples of the pathological discharge, a Volkmann spoon or an attic probe is used. With the help of these instruments, biological material is collected from the deep parts of the external auditory canal. Microscopic examinations are the most informative and reliable in making this diagnosis.
Differential diagnosis of fungal otitis should be carried out for the correct choice of treatment tactics to distinguish otomycosis from allergic otitis, bacterial otitis, ear neoplasms, eczema and other inflammatory processes of the external auditory canal and inner ear.
Treatment and prognosis of otomycosis
Treatment of otomycosis is based on the principles of getting rid of any fungal lesions, it should be aimed not only at eliminating fungal infection, but also other various factors that contribute to the development of this insidious disease. It is also worth remembering that fungal lesions of the ears in the vast majority of cases have a local, limited character. This makes it possible to completely sanitize the focus of infection with the help of local antifungal drugs.
During local therapy of otomycosis, it is necessary to prescribe not only antimycotic drugs, but also drugs that help eliminate the inflammatory process that has spread to the skin of the auditory canal (in the case of external mycotic otitis) or to the mucous membrane of the middle ear.
For external candidiasis, levorin and nystatin ointments, alcohol and aqueous solutions of quinosol, kanesten, multifungin are used. With mold otomycosis, local application of nitrofungin, alcohol solutions of gentian violet or quinosol, solutions of amphotericin B, kanesten are prescribed.
In the treatment of moderate otomycosis, local drugs are often combined with general ones. In addition to prescribing antifungal drugs, the patient should take anti-inflammatory, analgesic medications. If otitis is caused by mold fungi, the appointment of amphoglucamine and levorin is indicated. With candidiasis fungal otitis media, nizoral and nystatin are used.
For the effectiveness of the therapy used, a thorough cleaning of fungal masses is needed, often this is done with the help of 3% hydrogen peroxide.
Treatment usually lasts from three to four weeks. Sometimes, when positive effects appear, patients stop it, but this leads to exacerbations.
Despite the fact that the process of treating fungal lesions of the ears is quite difficult, the prognosis in 89% of cases remains positive. The main task of the doctor in the course of treatment is to establish the real etiological factor of the appearance of otomycosis, and then eliminate it. With the appearance of foci of fungal infection in the middle ear after adhesive processes and the development of an adhesive form of otitis, hearing loss can already become an irreversible process.
In isolated severe cases, fungal foci can spread to internal organs and cause mycotic sepsis. According to statistics, about 15% of patients with postoperative mycosis are susceptible to repeated fungal diseases.
