Endocrine Abstracts

Introduction: Pseudomonal infection is the most common cause of necrotizing otitis externa (NOE), which typically affects elderly diabetic patients. Fungi are a rare cause of this disease. Fungal NOE can be life-threatening if not recognized and treated promptly.

Objective: The aim of this study is to describe the epidemiology, clinical features, management and evolution after treatment of diabetic patients with fungal NOE.

Methods: This is a retrospective study about 17 diabetic patients diagnosed with fungal otitis externa between 1992 and 2022.

Results: This study is about 11 males and 6 females. The average age of the patients was 69 years (51 – 81 years). All of them had diabetes. Five of them, had terminal chronic renal failure. The symptoms included: otalgia and otorrhea in all cases and facial palsy in 4 cases. Fungi isolated from samples were: Candida albicans (4 cases), Candida glabrata (2 cases), Candida tropicalis (1 case) and Aspergillus flavus (10 cas). There was a case of a simultaneous bacterial infection. CT-scan showed lysis: in the temporal bone (all cases), the carotid canal (1 case), the facial nerve canal (1 case) and the jugular bulb (1 case). One patient had thrombosis in the intrapetrous carotid artery and the internal jugular vein. An extension to the parapharyngeal space was found in 3 cases. An extension to the temporo-mandibular joint was found in 5 cases. Treatment included maintaining euglycemic blood glucose levels and anti-fungal medicines (Fluconazole in 4 cases and Voriconazole in the other cases) for the average of 96 days. After treatment, 13 patients were free of disease, 1 patient had brain ischemia and 3 patient presented with recurrence.

Conclusion: Fungal NOE are known to be more aggressive than bacterial NOE. Aggressive disease, lack of response of NOE to antibacterial drugs or progression despite the use of these drugs should raise the suspicion of a fungal etiology of NOE. The current guidelines are lacking in terms of antifungal of choice and optimum duration of treatment.