The otomycosis are usually considered mild infections of the external ear canal whose evolution is favorable.However, when they occur on land at risk, evolution can be extremely serious. We report the case of a woman 60 years without immunosuppression, diabetes or suffering from a chronic bilateral otitis media. After several weeks of evolution, and the city establishment of an ineffective antibiotic therapy, combining a cephalosporin 3 rdgeneration fluoroquinolone, it is addressed to specialized consulting our hospital. The ENT examination revealed a bilateral purulent otorrhea with bilateral subtotal tympanic perforation associated with ossicular lysis with a fungal nail appearance. The audiogram found a significant conductive hearing loss (-30 to -40 dB) predominant right. Repeated local levies made under microscope after local washing, has isolated Aspergillus Niger , without associated bacteria. After determination of minimum inhibitory concentrations (MIC) for major antifungal, voriconazole therapy intravenously for 7 days is set, with a relay orally for a total period of 6 months. The evolution was rapidly favorable with disappearance of otorrhea, tympanic membrane restoration, but persistent hearing loss of 10dB.
Otomycosis represent the temperate zone of 5 to 10% of otitis externa. Aspergillus Niger is involved in 20-40% of cases. The otomycosis with bilateral ossicular lysis are exceptional in France. The main risk factors for these infections are trauma, iatrogenic (antibiotics or topical steroids, ear surgery) or a particular field (diabetes and immunosuppression). Our patient with no such risk factors. In the laboratory, isolation of the fungus is easy, rapid growth, and simple identification. Co-infection with a bacterium is common .. The determination of CMI is however essential, and falls within specialized centers. The study of antifungal susceptibility usually found sensitivity to imidazoles (itraconazole, voriconazole) and amphotericin B. The treatment of these invasive forms required hospitalization for initiation systemically, with a full period of several weeks to several months. Functional sequelae are common, sometimes with the need for reconstructive surgery. Finally, these exceptional invasive otomycosis usually alternate with mild forms localized importance of dealing effectively and early. In the absence of this early therapeutic management adapted, the functional prognosis of the ear can be engaged, and the patient exposed to a therapeutic long, cumbersome and expensive.
Full conference title:
- RICAI 29th (2009)