Endocrine Abstracts

Introduction: Fungal necrotizing otitis externa is a serious and potentially life-threatening condition that is challenging to manage. Diabetic patients are susceptible to develop this severe infection. The diagnosis is often delayed and its frequency has increased over the last few years.

Material and Methods: we reported 8 cases of fungal necrotizing external otitis in diabetic patients treated in the ENT department of Tahar Sfar Hospital in Tunisia from 1992 to 2018.

Results: Our study investigated three men and five women. They were all diabetics. The mean age was 61 years ranging from 69 to 74 years. All four patients were first treated for bacterial necrotizing otitis externa. Diagnosis was reviewed after a lack of response to antibiotic therapy. Aspergillus flavus was isolated in one case, Candida albicans was isolated in 6 cases an association of candida and aspegillus flavus was found in one case. Computed tomography scan showed signs of invasive necrotizing external otitis in all cases. It showed lysis of the facial canal in one case, sigmoid sinus thrombosis in one case, jugular vein thrombosis in one case and lysis of the carotid canal in one case. One patient developed facial palsy during disease progression. The equilibration of diabetes was obtained in all the cases. Treatment was based on amphotericin B and oral voriconazole during 6 months. Heparin was not used for the cases of septic thrombosis. The side effets of the antifungal treatment are carefully monitoring. After an average follow-up of one year, a regression of the infection was observed in 5 cases, one patient was not followed up, one patient developped a recurrence and one patient died with heart stroke.

Conclusion: Fungal necrotizing otitis externa should be suspected in cases where there is no response to antipseudomonal antibiotic therapy. Deep biopsies from the external auditory canal or the mastoid are usually needed to confirm the diagnosis.