title: Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review.
abstract: BACKGROUND
  Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.
  
  
  METHODS
  We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.
  
  
  RESULTS
  In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.
  
  
  CONCLUSIONS
  This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.
authors.affiliation: Division of Otorhinolaryngology, Department of Surgery,Buddhist Dalin Tzu Chi Hospital,Chiayi,Taiwan.
authors.forename: Hsu-Chueh
authors.initials: HC
authors.lastname: Ho
authors.affiliation: Division of Otorhinolaryngology, Department of Surgery,Buddhist Dalin Tzu Chi Hospital,Chiayi,Taiwan.
authors.forename: Shih-Hsuan
authors.initials: SH
authors.lastname: Hsiao
authors.affiliation: Division of Otorhinolaryngology, Department of Surgery,Buddhist Dalin Tzu Chi Hospital,Chiayi,Taiwan.
authors.forename: Cheng-Yung
authors.initials: CY
authors.lastname: Lee
authors.affiliation: School of Medicine,Tzu Chi University,Hualien,Taiwan.
authors.forename: Chen-Chi
authors.initials: CC
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059249:Otomycosis / Q000188:drug therapy*; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole