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Candidal otitis externa — Clinical Guidelines

Overview

Candidal otitis externa, also known as fungal otitis externa, is an infection of the external auditory canal caused by Candida species, often complicating chronic otitis externa or occurring in immunocompromised individuals 1 2.

Diagnosis

Clinical presentation includes otalgia, otorrhea, and conductive hearing loss 1 2.

Visualization of white, curd-like discharge and edema in the ear canal on otoscopy 1 2.

Microbiological confirmation through fungal culture or microscopy of ear discharge 1 2.

Management

First-line treatment: Antifungal drops such as topical clotrimazole or nystatin 1 2.

Adjunctive measures: Ensuring proper ear canal drying and avoiding moisture exposure 1 2.

Consideration for recalcitrant cases: Oral antifungal agents like fluconazole may be necessary 1 2.

Special Populations

Pediatrics: Similar management principles apply, but careful dosing and monitoring are crucial 1 2.

Elderly and immunocompromised: Higher vigilance for complications and potential need for systemic antifungal therapy 1 2.

Key Recommendations

Utilize telehealth platforms with patient-guided smartphone videoscopes for remote monitoring and assessment of ear conditions, enhancing accessibility and continuity of care (Evidence: Moderate) 1.

Employ topical antifungal agents as first-line therapy for candidal otitis externa, with consideration for systemic treatment in refractory cases (Evidence: Moderate) 1 2.

Ensure comprehensive training in interpersonal skills for otolaryngology residents to improve patient interaction and telehealth effectiveness (Evidence: Expert opinion) 3.

References

1 Cai Y, Zheng YJ, Gulati A, Butrymowicz A, Krauter R, Pletcher SD et al.. Patient Use of Low-cost Digital Videoscopes and Smartphones for Remote Ear and Oropharyngeal Examinations. JAMA otolaryngology-- head & neck surgery 2021. link 2 Yulzari R, Bretler S, Avraham Y, Sharabi-Nov A, Even-Tov E, Gilbey P. Mobile Technology-Based Real-Time Teleotolaryngology Care Facilitated by a Nonotolaryngologist Physician in an Adult Population. The Annals of otology, rhinology, and laryngology 2018. link 3 Lu-Myers Y, Myers CG. Incorporating Interpersonal Skills into Otolaryngology Resident Selection and Training. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2018. link 4 Roark RM, Schaefer SD, Yu GP, Branovan DI, Peterson SJ, Lee WN. Assessing and documenting general competencies in otolaryngology resident training programs. The Laryngoscope 2006. link

Candidal otitis externa