Aspergillus versus Candida infection of the ear canal

What it is

Otomycosis is a fungal infection of the external auditory canal. Otitis externa is divided on an aetiological basis into an infective group and a reactive group. The infective group is bacterial (localized otitis externa or furuncle, diffuse otitis externa, malignant otitis externa), fungal (otomycosis), and viral. The reactive group covers eczematous, seborrhoeic and neurodermatitis forms. The fungi that cause otomycosis are Aspergillus and Candida, and the most common organisms are Aspergillus niger and Candida albicans.

Causes and risk

Contaminated water, a hot and humid climate, and prolonged use of topical antibacterial are the risk factors for otomycosis. The risk factors that apply to otitis externa in general also matter: a narrow ear canal, swimming, trauma, devices that occlude the ear canal such as hearing aids or earphones, and dermatologic conditions such as psoriasis and atopic dermatitis.

How it presents

Intense itching, otalgia, and a watery discharge with a musty odor are the main features, often with a sense of ear blockage or a foreign body sensation. Conductive hearing loss with aural fullness may be found. The changes sit in the medial aspect of the ear canal.

The otorrhoea of otitis externa is thick and scanty, and what goes with it points to the cause: yellow purulent goes with bacterial disease and white fluffy with fungal disease. Pruritis goes with the fungal form, and a post auricular lymph node may be felt.