Faculty Collaboration Database

Fungal causes of otitis externa and tympanostomy tube otorrhea. Int J Pediatr Otorhinolaryngol 2005 Nov;69(11):1503-8

Date

06/02/2005

Pubmed ID

15927274

DOI

10.1016/j.ijporl.2005.04.012

Scopus ID

2-s2.0-26844549389 (requires institutional sign-in at Scopus site)   70 Citations

Abstract

OBJECTIVE: To describe the occurrence of fungal organisms in the setting of otitis externa and tympanostomy tube otorrhea, review the treatment course, timing of diagnosis, organism identified and time to resolution with fungal infections.

DESIGN: Retrospective review.

SETTING: Pediatric otolaryngology clinic within a tertiary care hospital.

PATIENTS: One hundred and sixty-six patients (ages 16 days to 18 years) with fungal organisms on ear culture.

OUTCOME MEASURES: Number of prior therapies, number of office visits, time to resolution and anti-fungal therapy.

RESULTS: Ear cultures positive for fungal organisms were found in 166 patients seen between 1 January 1996 and 30 September 2003 from a total of 1242 patients undergoing ear culture. Comparing the 3-year period (1996-1998) prior to the availability of fluoroquinolone ototopical drops to the 3-year period after (1999-2001), there is a statistically significant increase in the incidence of positive fungal culture (p<0.001). Otitis media was diagnosed in 72% of these children, with otitis externa comprising 25%. Approximately 3% carried a diagnosis of both otitis externa and otitis media. Candida albicans was identified in 43% of fungal organism-positive cultures. Candida parapsilosis was found in 24% of and Aspergillus fumigatus in 13%. The remainder of the cultures yielded three other Candida and three other Aspergillus species, each at less than 5%. Time to resolution ranged from 1 week to 9 months, with a median of 3.8 weeks for symptom resolution. Patients were treated with an average of 1.7 oral antibiotics and 1.1 ototopical agent before a culture was taken.

CONCLUSIONS: Otorrhea due to fungal organisms occurs in the setting of refractory infection and is often discovered after multiple oral and ototopical antibacterial medications. Due to the extended treatment period required to clear fungal organism, timely diagnosis with culture for bacteria and fungus is required in patients with persistent otorrhea. An increase in incidence of fungal infections of the ear was found in the period after widespread use of ofloxacin began.

Author List

Martin TJ, Kerschner JE, Flanary VA

Authors

Valerie A. Flanary MD Director, Professor in the Otolaryngology department at Medical College of Wisconsin
Joseph E. Kerschner MD Provost, Executive Vice President, Dean, Professor in the School of Medicine Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Antifungal Agents
Aspergillus
Candida
Cerebrospinal Fluid Otorrhea
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Middle Ear Ventilation
Mycoses
Otitis Externa
Otitis Media
Retrospective Studies
Scedosporium
Trichosporon