title: Fungal causes of otitis externa and tympanostomy tube otorrhea.
abstract: OBJECTIVE
  To describe the occurrence of fungal organisms in the setting of otitis externa and tympanostomy tube otorrhea, review the treatment course, timing of diagnosis, organism identified and time to resolution with fungal infections.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Pediatric otolaryngology clinic within a tertiary care hospital.
  
  
  METHODS
  One hundred and sixty-six patients (ages 16 days to 18 years) with fungal organisms on ear culture.
  
  
  METHODS
  Number of prior therapies, number of office visits, time to resolution and anti-fungal therapy.
  
  
  RESULTS
  Ear cultures positive for fungal organisms were found in 166 patients seen between 1 January 1996 and 30 September 2003 from a total of 1242 patients undergoing ear culture. Comparing the 3-year period (1996-1998) prior to the availability of fluoroquinolone ototopical drops to the 3-year period after (1999-2001), there is a statistically significant increase in the incidence of positive fungal culture (p<0.001). Otitis media was diagnosed in 72% of these children, with otitis externa comprising 25%. Approximately 3% carried a diagnosis of both otitis externa and otitis media. Candida albicans was identified in 43% of fungal organism-positive cultures. Candida parapsilosis was found in 24% of and Aspergillus fumigatus in 13%. The remainder of the cultures yielded three other Candida and three other Aspergillus species, each at less than 5%. Time to resolution ranged from 1 week to 9 months, with a median of 3.8 weeks for symptom resolution. Patients were treated with an average of 1.7 oral antibiotics and 1.1 ototopical agent before a culture was taken.
  
  
  CONCLUSIONS
  Otorrhea due to fungal organisms occurs in the setting of refractory infection and is often discovered after multiple oral and ototopical antibacterial medications. Due to the extended treatment period required to clear fungal organism, timely diagnosis with culture for bacteria and fungus is required in patients with persistent otorrhea. An increase in incidence of fungal infections of the ear was found in the period after widespread use of ofloxacin began.
authors.affiliation: Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Martin
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Kerschner
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Flanary
mesh_terms: D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D002558:Cerebrospinal Fluid Otorrhea / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy; D010032:Otitis Externa / Q000188:drug therapy* / Q000382:microbiology; D010033:Otitis Media / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D021681:Scedosporium / Q000302:isolation & purification; D014250:Trichosporon / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents