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Marwen Ghabi
EPS Charles Nicolle, TunisiaTitle: Fungal necrotizing external otitis: Place of antifungal treatment
Abstract
Introduction: Necrotizing External Otitis
(NEO) is a serious condition. We are increasingly seeing the emergence of
fungal agents that cause this condition.
Methods: A retrospective study carried
out over a period of 10 years, from 2010 to 2020, including 21 patients with
fungal NEO treated in our department. The fungal origin was retained in front
of an ear sample isolating a fungal agent.
Results: The mean age was 65.76 ± 7.3
years. The sex ratio M / F was 1.6. All our patients were diabetic and 13
patients had hypertension. The main complaint was otalgia followed by otorea in
16 cases and hearing loss in 4 cases. The median time between symptom onset and
hospitalization was 30 days [14-120]. Oral antibiotic therapy before admission
was prescribed in 20 patients, 8 of whom also received topical antibiotic
treatment. Otoscopy showed that External Auditory Canal (EAC) was stenotic in
all cases with an average degree of stenosis of 49.7%. Three patients had
clinical involvement of the Temporo Mandibular Joint (TMJ) (14.3%). Six
patients had peripheral facial palsy. Biological examination, the mean
sedimentation rate was 74, the median CRP level was 16.6, the median fasting
blood sugar level was 2.3. Bacteriological and mycological samples were taken
in all cases and redone in 6 cases. The fungal agents isolated were: Candida
Albicans in 7 cases, Candida Para psilosis in 5 cases, Aspergillus Niger in 4
cases, Aspergillus Flavus in 3 cases, Candida Tropicalis in 1 case, Candida
Famata in 1 case. Nine bacterial cultures were positive. Aspergillus serology
was carried out in 11 cases and were positive in only 2 cases. Computed
tomography was performed in all patients within a median of 2 days of
admission, revealed EAC filling and lysis of the tympanic bone in all cases,
extension to TMJ in 11 cases, an extension to the deep spaces of the face in 8
cases (38.1%), an involvement of the soft parts in 5 cases, an extension to the
deep spaces of the face in 8 cases, osteitis of the base of the skull in 2
cases and lysis of the facial nerve canal in one case. A probabilistic double
antibiotic therapy targeting Pseudomonas was started after taking samples from
all patients. Eleven patients received antifungal treatment (8 received
voriconazole and 3 received fluconazole). The median length of hospital stay
was 29 days [14-117]. Six patients retained PFP after a 3-month follow-up. Four
of the 11 patients treated with an antifungal were readmitted (19%).
Conclusion: The isolation of fungal agents
during NEO is probably a result of infection secondary to local and oral
antibiotic therapy initially initiated. The initiation of antifungal therapy
during an OEN should be carefully considered given its many side effects.
Confirmation of the diagnosis must be based on biopsies rather than a
superficial sample to be able to incriminate the fungal agent in the genesis of
this pathology.
Biography
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