Aspergillosis of the middle ear in 37 immunocompetent patients

Introduction
Aspergillus spp. constitute the most common causative agents of fungal otitis. In the literature, only few manuscripts concerning middle ear infection with this pathogen can be found. Objective: To evaluate a series of 37 consecutive immunocompetent patients with chronic otitis media (COM) co-infected with Aspergillus spp.

Material and methods
Detailed analysis of the clinical course, risk factors and results of treatment was performed.

Results
In all cases, persistent ear discharge was a dominant symptom. Two patients were hospitalized and operated on due to the complications of otogenic origin. A. niger complex constituted 50% of all isolates, A. flavus complex – 29%, while A. fumigatus complex – 21%. In 60% of cavities after canal wall-down mastoidectomies, A. fumigatus complex was cultured. In all cases with cholesteatoma and granulation, surgical removal of the lesions (during tympanomastoidectomy procedures) was performed. In all patients treated by closed technique, voriconazole was administered just after initial microbiological confirmation of conidial fungi in microscopic examination. In patients after canal wall-down tympanomastoidectomies, regular cleansing of mastoid cavities followed by topical boric acid was the first-line and effective treatment method.

Conclusions
Surgery accompanied and followed by systemic antifungal therapy seems to be the best treatment option in the middle ear aspergillosis. In unstable canal wall down mastoid cavities infected with Aspergillus spp., regular cleansing and boric acid are an effective treatment choice.