title: [Fungal necrotizing external otitis].
abstract: OBJECTIVE
  Fungal necrotizing otitis externa is rare, although its frequency has increased over the last few years. We report four cases, which to our knowledge make up the largest series published and discuss the main diagnostic problems and the management of this infection.
  
  
  METHODS
  Our study investigated two men and two women, all diabetics, aged between 69 and 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 and Candida parapsilosis were the fungal agents isolated in each of the two patients. Diagnosis was established based on the pathological specimen for one patient. The last patient was treated without identifying the causal fungus. Two patients developed facial paralysis during disease progression. Treatment was based on intravenous amphotericin B and oral itraconazole. Three patients are now free of disease after a three- to six-month course of antifungal therapy; one patient was not followed up.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service d'ORL et de chirurgie cervicofaciale, CHU Farhat-Hached, avenue Ibn-ElJazzar, Sousse 4000, Tunisie. mani_radhouane@yahoo.fr
authors.forename: Radhouane
authors.initials: R
authors.lastname: Mani
authors.forename: Malek
authors.initials: M
authors.lastname: Belcadhi
authors.forename: Nessrine
authors.initials: N
authors.lastname: Krifa
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelkefi
authors.forename: Moncef
authors.initials: M
authors.lastname: Ben Said
authors.forename: Kamel
authors.initials: K
authors.lastname: Bouzouita
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009336:Necrosis / Q000150:complications*; D010032:Otitis Externa / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole