Prevalencia del síndrome del edificio enfermo en trabajadores de la industria manufacturera / Prevalence of sick building syndrome in manufacturing industry workers

El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)

Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)

Profil Épidémiologique et Mycologique de l'Otomycose à l'Hôpital Général de Référence de Niamey (Niger) / Epidemiological and my cologica l profile of otomycosisat the Genera l Reference Hospital o f Niamey (Niger

But. Décrire les caractéristiques épidémiologiques et mycologiques de l'otomycose à Niamey. Méthodologie.Il s'est agi d'une étude rétrospective menée sur 3ans au service d'ORL et CCF de l'Hôpital Général de Référence, portant sur les patients chez qui le diagnostic d'otomycose a été posé. Les paramètres étudiés étaient épidémiologiques et mycologiques. Résultats. En 3 ans, nous avons enregistré 447 consultations pour otites dont 56 avaient une otomycose, soit une fréquence de 12,53% de l'ensemble des otites et 58,92% des otites externes. L'âgemoyen était de 35,75 ans (extrêmes de 2 et 70 ans). La tranche d'âge de 31 à 60 ans représentait 58,93% des patients. Nous avons retrouvéune prédominance féminine (67,85%), (p=0,0752). Les principaux facteurs favorisant l'otomycose étaient le nettoyage de l'oreille au coton tige ou à la plume de volaille : (53,57%),le port du turban ou de couvre-chef, (46,42%), la baignade (16.07%), l'étroitesse du conduit auditif externe (8,92%) et le port de prothèse auditive externe intra-conduit (5,35%,). Sur le plan mycologique, le Candida albicanset l'Aspergilus nigeront représenté respectivement 19,44% et 33,33% des espèces fongiques isolées en culture. Conclusion. L'otomycose est une infection fréquente en Orl à Niamey. Le nettoyage de l'oreille au coton tige ou à la plume de volaille venait au premier rang des facteurs favorisant l'otite fongique. L'Aspergilus nigeret le Candida albicansétaient les germes les plus fréquemment isolés.

Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial / Eficácia do clotrimazol tópico versus tolnaftato tópico no tratamento da otomicose: um ensaio clínico controlado randomizado

Abstract Introduction: Otomycosis, an infection of the ear canal by fungi, is prevalent in hot and humid weather. Nevertheless, there is not sufficient evidence for the effectiveness of different topical antifungal treatments. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Currently there are not sufficient studies that prove its efficacy. Objectives: To compare the efficacy of clotrimazole and tolnaftate administration in the treatment of otomycosis. Material and methods: A controlled, randomized and open clinical trial included patients diagnosed with fungal external otitis who were treated with topical antifungals, randomized into two treatment groups: (1) clotrimazole cream; (2) tolnaftate solution. They were microscopically evaluated at one and two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed. Follow-up and final outcomes (absence of infection) were compared between groups. Results: Forty eight patients were included, 28 in the clotrimazole group and 20 in the tolnaftate group. Spring was the weather most commonly associated with otomycosis, while otic manipulation was the risk factor more common in both groups. Predominant symptoms were itching and otic fullness. Aspergillus niger organism was isolated most frequently. Treatment with clotrimazole resulted in 75% resolution vs 45% resolution with treatment with tolnaftate at one week of treatment (p = 0.007). The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures, 20% and 15% respectively. Conclusions: Clotrimazole cream treatment is more effective than tolnaftate for uncomplicated otomycosis. More studies are needed to corroborate our results.

Resumo Introdução: Otomicose, uma infecção fúngica do canal auditivo externo, é prevalente em climas quentes e úmidos. No entanto, a literatura não apresenta evidências suficientes sobre os diferentes tratamentos antifúngicos tópicos. O tolnaftato é um antifúngico tópico descrito como eficaz no tratamento da otomicose; entretanto, sua eficácia não está suficientemente comprovada. Objetivo: Comparar a eficácia do uso de clotrimazol e tolnaftato no tratamento da otomicose. Material e método: Ensaio clínico controlado e randomizado; incluiu pacientes diagnosticados com otite externa fúngica tratados com antifúngicos tópicos, randomizados em dois grupos de tratamento: 1) clotrimazole (creme); 2) solução de tolnaftato. Eles foram avaliados microscopicamente uma e duas semanas após o início do tratamento para avaliar a resolução da doença. Recorrência e intercorrências foram registradas; além disso, as variáveis demográficas e clínicas foram coletadas e analisadas. Os dados do acompanhamento e desfechos finais (ausência de infecção) foram comparados entre os grupos. Resultados: O estudo incluiu 48 pacientes, 28 dos quais foram alocados ao grupo clotrimazole e 20 ao grupo tolnaftato. A primavera foi a estação mais comum; a manipulação foi o fator de risco mais comum em ambos os grupos. Os sintomas mais comuns foram coceira e plenitude auricular. Aspergillus niger foi o micro-organismo mais comumente isolado. Após uma semana, o tratamento com clotrimazol apresentou uma taxa de resolução de 75% vs. 45% com o tratamento com tolnaftato (p = 0,007). O tratamento com tolnaftato apresentou maiores taxas de recidiva e falhas: 20% e 15%, respectivamente. Conclusões: Em casos de otomicose não complicada, o uso de clotrimazol (creme) é mais eficaz do que o de tolnaftato. Mais estudos são necessários para corroborar os presentes resultados.

Single Dose Topical Application of Clotrimazole for the Treatment of Otomycosis: Is This Enough?

BACKGROUND AND OBJECTIVES: To determine the efficacy of filling the external auditory meatus with 1% clotrimazole at a single visit for the treatment of otomycosis. SUBJECTS AND METHODS: This prospective study included 40 patients who were referred to our clinic with complaints of ear itching, pain, and fullness, and were diagnosed with unilateral otomycosis. After cleaning the mycotic hyphae from the external auditory meatus, the ear canal was filled with 1% clotrimazole, using an intravenous catheter and syringe. The patients received follow-up examinations on post-treatment days 7, 15, and 45. RESULTS: The follow-up otomicroscopic examinations revealed that 95% of the ear canals were entirely clean and that all symptoms had resolved. The post-treatment scores of pain, aural fullness and itching were significantly lower than the pre-treatment scores (p < 0.01). CONCLUSIONS: Filling the external auditory meatus with 1% clotrimazole at a single visit is an easy, efficient, and cost-effective treatment for otomycosis. Additionally, high patient compliance makes this treatment superior to long-term topical therapy.

Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience

Abstract Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.

Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment / Comparação da taxa de recuperação de otomicose com o uso de tratamento tópico com betadina e clotrimazol

Abstract Introduction Otomycosis is a common diseases that can be associated with many complications including involvement of the inner ear and mortality in rare cases. Management of otomycosis can be challenging, and requires a close follow-up. Treatment options for otomycosis include local debridement, local and systemic antifungal agents and utilization of topical antiseptics. Objective This study was designed to compare the recovery rate of otomycosis using two therapeutic methods; topical betadine (Povidone-iodine) and clotrimazole. Methods In this single-blind clinical trial, 204 patients with otomycosis were selected using a non-probability convenient sampling method and were randomly assigned to two treatment groups of topical betadine and clotrimazole (102 patients in each group). Response to treatment was assessed at 4, 10 and 20 days after treatment. Data were analyzed using the independent t-test, Chi-Square and Fisher exact test in SPSS v.18 software, at a significance level of p < 0.05. Results The results showed that out of 204 patients with otomycosis, fungi type isolated included Aspergillus in 151 cases (74%), and Candida albicans in 53 patients (26%). On the fourth day after treatment, 13 patients (13.1%) in the group treated with betadine and 10 patients (9.8%) in the group treated with clotrimazole showed a good clinical response to treatment (p = 0.75). A good response to treatment was reported for 44 (43.1%) and 47 patients (46.1%) on the tenth day after the treatment (p = 0.85); and 70 (68.6%) and 68 patients (67.6%) on the twentieth day after treatment (p = 0.46) in the groups treated with betadine and clotrimazole, respectively. The response to treatment was thus not significantly different in the two groups. Conclusion In the present study the efficacy of betadine and clotrimazole was the same for the treatment of otomycosis. The result of this study supports the use of betadine as an effective antifungal in otomycosis treatment, helping to avoid the emergence of resistant organisms.

Resumo Introdução A otomicose é uma das doenças comuns associadas a muitas complicações, como envolvimento da orelha interna e mortalidade em casos raros. O tratamento da otomicose pode ser realmente desafiador e requer um acompanhamento rigoroso. As opções de tratamento para otomicose podem incluir desbridamento local, agentes antifúngicos locais e sistêmicos e uso de antissépticos tópicos, os medicamentos tópicos recomendados para o tratamento da otomicose. Objetivo Comparar a taxa de recuperação de otomicose utilizando dois métodos terapêuticos de betadina tópica (povidona-iodo) e clotrimazol. Método Neste ensaio clínico simples cego, 204 pacientes com otomicose foram selecionados utilizando-se método de amostragem de não probabilidade conveniente e randomizados para dois grupos de tratamento, com betadina tópica e com clotrimazol (102 pacientes em cada grupo). A resposta ao tratamento foi avaliada aos 4, 10 e 20 dias após o tratamento. Os dados foram analisados utilizando o teste t independente, qui-quadrado e teste de Fisher no software SPSS v.18, com nível de significância de p < 0,05. Resultados Os resultados mostraram que dos 204 pacientes com otomicose, os tipos de fungos isolados incluíram Aspergillus em 151 casos (74%) e Candida albicans em 53 pacientes (26%). No quarto dia após o tratamento, 13 pacientes (13,1%) no grupo tratado com betadina e 10 pacientes (9,8%) no grupo tratado com clotrimazol apresentaram boa resposta ao tratamento (p = 0,75). Uma boa resposta ao tratamento foi relatada para 44 (43,1%) e 47 pacientes (46,1%) no décimo dia após o tratamento (p = 0,85); e 70 (68,6%) e 68 pacientes (67,6%) no vigésimo dia após o tratamento (p = 0,46) no grupo tratado com betadina e clotrimazol, respectivamente. Assim, a resposta ao tratamento não foi significativamente diferente nos dois grupos. Conclusão No presente estudo, a eficácia da betadina e do clotrimazol foi a mesma no tratamento da otomicose. O resultado deste estudo apoia o uso de betadina como um antifúngico eficaz no tratamento da otomicose que pode ajudar a evitar o surgimento de organismos resistentes.

Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

Locacorten Vioform Ototoxicity Upon Guinea Pig Middle Ear Application

BACKGROUND AND OBJECTIVES: Locacorten Vioform (Novartis UK) is frequently prescribed for otomycosis. Its component, Clioquinol, also has anti-bacterial properties. Up to this point, its ototoxic potential has not been evaluated. Our objective aims to evaluate Locacorten Vioform’s potential ototoxicity when applied directly to the middle ear cavity. MATERIALS AND METHODS: We performed an experimental prospective animal study in our animal research center with 20 Hartley guinea pigs divided into 2 groups. The first group (experimental) was treated with Locacorten Vioform in one ear and with a physiologic saline solution in the other. The second group (positive control) was treated with concentrated gentamycin in one ear and physiologic saline in the other. Auditory brainstem response measurements were obtained before and after three sets of injections. Statistics were analyzed using a variance analysis with repeated measures. The histological state of cochlear outer hair cells was compared between the two groups using scanning electron microscopy. RESULTS: Average hearing loss in ears treated with Locacorten Vioform was 32.1 dB, compared with a 2.5 dB average loss in the saline-treated ears. Ears treated with gentamycin lost an average of 33.0 dB. There were clinically and statistically significant differences between the two ears of the guinea pigs in both groups (p < 0.001). Scanning electron microscopy revealed severe pericochlear and cochlear inflammation and ossification in the Locacorten Vioform-treated ears. Gentamycin caused significant destruction of outer hair cell architecture. CONCLUSIONS: Locacorten Vioform induces a hearing loss similar to that caused by gentamycin when applied directly to the middle ear of a guinea pig model. Electron microscopy indicates a pericochlear and cochlear inflammatory reaction with ossification.

Fungus culture of the ear discharge and therapeutic effects in 60 outpatients with otitis externa / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To assess the diagnosis and therapeutic effects for fungal otitis externa by clinical symptoms, endoscopic findings, and fungus culture of the ear discharge.@*METHOD@#Sixty outpatients diagnosed with otitis externa were enrolled in the study. All patients were treated with a thorough debridement of the ear and one antifungal medication regimens (compound resorcinol solution) in case of a positive fungus culture. One subgroup of patients treated with daub glycerol during 2 weeks of follow-up.@*RESULT@#Positive cultures were found in 42 cases. The efficacy was observed in all patients even in those who received only ear endoscopy.@*CONCLUSION@#Fungal otitis externa could be easily diagnosed by ear endoscopy. A thorough debridement of the ear and utility of compound resorcinol solution is an easy and effective approach for treatment of fungal otitis externa.

role of various outpatients aural toileting procedures in the treatment of otomycosis

Otomy costs is not uncommon clinical problem requiring a long term treatment and has a recurrence tendency. Meticulous cleansing especially of anterior metal recess is the treatment mainstay. The aim of this work is to determine the clinical presentation and predisposing factors, compare the efficacy of aural toileting procedures and to assess the syringing role as a safe effective procedure for deep meatal recess debris removal. A randomized prospective comparative study conducted on 91 patients [99 ears] in ENT consultation clinic- Sulaimani Teaching Hospital from April 2007 till November 2008. Patients were divided into two groups: group A underwent ear syringing and group B underwent dry suction cleansing. Data entry and analysis carried out by [Statgraphics] software version 15 [2008]. Presenting symptoms were otalgia [94.5%], ear fullness [74.72%], itching [58.24%], hearing impairment [40.65%], otorrhea [20.87%] and headache [14.82%]. Predisposing factors were ear moisture [94.5%], self cleansing habit [62.63%], ototopical agent overuse [36.26%] and dermatophytosis [19.78%]. Dry cleaning showed complete debris removal in 31 [63.26%] ears and incomplete removal in 18 [36.73%] ears while syringing showed complete removal in 38 [76%] ears and incomplete removal in 12 [24%] ears. Dry cleaning adverse effect was 37.37% compared to 12.12% in wet group. There was insignificant statistical differences [Chi-squared, p=0.3411] between the two regimens and both can be used for treatment. However, clinically gentle ear syringing is less time consuming, less complicated and more meticulous in deep recess cleaning

Tympanic membrane disintegration by otomycosis

To report ear drum disintegration in cases of otomycosis. Case series study. E.N.T and Head and Neck Surgery Department PNS Shifa Hospital Karachi and E N T Department of Combined Military Hospital, Quetta Cantt from August 2009 to October 2010. 242 patients with clinical diagnosis of otomycosis were registered over a period of 15 months. On registration ear was meticulously cleaned under microscope removing fungal debris to establish the integrity of eardrum. In the same sitting cream with combination of triamcinolone acetonide, neomycin sulphate, gramicidin, nystatin was applied all around within external auditory meatus [EAM] on effected walls and same drops were advised locally thrice daily for 3 to 5 days. Every patient was advised to report back immediately on occurrence of irritation, earache, ear discharge, blockage of ear and pain. Out of 242patients [140 males and 102 females] 110 [45.45%] were cured after single visit as outpatient adopting a regimen of single application of antifungal cream and thrice daily antifungal ear drops for 5 days after proper cleaning of fungal debris from EAM. 73 [30.16%] cases were cured of otomycosis after two sittings of same regimen. 59 [24%] patients neglected the otomycosis for days to weeks till the time pain became unbearable. In 18 [7.43%] patients ear drum was perforated by otomycosis and all these patients had neglected the disease. Neglected Qtomyeosis has all the potentials to create a defect in ear drum causing chronic disability .Meticulous cleaning and local antifungal therapy still remains the gold standards for curing otomycQsis

[Antifungal effect of cerumen on fungi causing otomycosis]

Otomycosis which is caused by saprophytic fungi can be treated by topical antifungal agents. Sometimes eradication of the disease is difficult in patients with risk factors. Considering controversies about the anti-microbial effect of cerumen, this research was performed in Babul, was focused on revealing the antifungal effect of cerumen of healthy people on fungi causing otomycosis. This experimental study was carried out on the 60 samples of healthy people's ear canal secretion. The average ages of the subjects were between 2-85 years. The antifungal activity of cerumen solution on 4 species of fungi including; Aspergillus fumigatus, Aspergillus niger, Candida albicans [clinical isolate] and standard Candida albicans were analyzed by paper disc diffusion and micro dilution methods. 10% of cerumen showed antifungal activity in paper disc diffusion; whereas in the micro dilution method all of samples had antifungal activity. The most antifungal effect observed was on Aspergillus niger [27 samples] and the least effect on the species of Candida albicans [16 samples]. According to the obtained results, cerumen has different effects on fungal growth, thus it is necessary to study more about components of cerumen for new approaches in future

A Case of Fungal Ball of Aspergillus in Chronic Otitis Media / 대한이비인후과학회지

Fungal infections in the ear of immunocompetent patients are mainly observed as otomycosis within the external auditory canal. Benign fungal colonization (fungal ball), though they are common in the paranasal sinuses, has never been reported in the middle ear cavity of a healthy population. We present a case of fungal ball in the middle ear of a 30-year-old, immunocompetent male. He did not have any illness except chronic suppurative otitis media in the right ear. On physical examination, only small central perforation was seen in the right tympanic membrane. Temporal bone computed tomography did not reveal any abnormal finding except thickened tympanic membrane. Intraoperative examination demonstrated a dark gray, cheese-like material in the mesotympanum. After tympanoplasty, mycological staining and histopathologic examination identified the surgical sample to be Aspergillus. So we reported, with a review of literature, the first case of Aspergilloma occurring in the middle ear of a healthy patient.

A Clinicomycologic Study of Dermatophytosis of the External Auditory Meatus / 대한피부과학회지

BACKGROUND: Otomycosis is a mycotic disease of the external auditory meatus. Aspergillus is the most common pathogen. Despite the fact that a great number of fungi are considered as the cause of otomycosis, otomycosis due to dermatophytes occurs with great rarity. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of dermatophytosis in the external auditory meatus. METHODS: We performed a clinical and mycologic analysis of 17 patients who had been clinically and mycologically diagnosed with dermatophytosis of the external auditory meatus. In addition, amplication of TRS-1 and TRS-2 of the ribosomal DNA nontranscribed spacer was performed on strains of Trichophyton (T.) rubrum and T. raubitshcekii which were isolated from skin lesions of the external ear and cerumen in 6 patients. RESULTS: The ratio of male to female patients was 1.4:1. The age of patients were 6 to 72 and mean age of onset is 36.4. Eleven patients had concomitant dermatophytosis of other sites. Tinea unguium was combined in 7 cases, tinea pedis in 4 cases, tinea corporis in 3 cases, tinea manus in 2 cases and tinea cruris in 1 case. The positive rate of KOH examination was 88.2% and the positive rate of fungal culture on PDAC media was 88.2%. The most common organism cultured was T. rubrum (80.0%), followed by T. raubitschekii (13.3%) and T. mentagrophytes (7.7%). Ten patients were treated with topical terbinafine and seven patients with oral itraconazole, so all patients were cleared of fungi from the external auditory meatus and inflammation was resolved. With TRS-1 and TRS-2 amplication, 4 of 5 pairs of T. rubrum and 3 strains of T. raubitshcekii showed the same types regardless of the site in each patient. CONCLUSION: Dermatophytosis occurs rarely in the external auditory meatus but we experienced 17 cases of dermatophytosis at this site. With suspected otomycosis, dermatophytosis of the external auditory meatus and concomitant dermatophytosis must be investigated and treated simultaneously to prevent any recurrence.

Prevalence et facteurs favorisants des otomycoses traitees en milieu hospitalier a Abidjan (Cote d'Ivoire)

Otomycosis is fre q u e n t ly encountered in tropical and subtropical zones. In Ivory Coast diagnosis of this disease is often based solely on the clinical symptoms. The objectives of this study were to determine the prevalence; predisposing factors; and etiologic agents associated with otomycosis at the Treichville University Hospital Center in Abidjan; Ivory Coast. M y c o l ogical examinations we re perfo rmed on specimens obtained from 115 patients presenting with external otitis at the d'Oto-Rhino-Laryngology Department. Fungi-positive cultures were obtained in 49 patients for an overall otomycosis prevalence of 42.6 (95Confidence Interval (CI); 34.4-52.2). Univa ri ate analysis showed that the predisposing fa c t o rs for otomycosis we re frequent swimming in natural or artificial pools (Relative Risk (RR) 3.7; CI 1.7-8.1); daily ear cleaning (RR 3.5; CI 1.8-6.8) and excessive use of eardrops containing antibiotics and corticoids (RR = 9.3; IC95= 4.3-20.1). The most common etiologic agents were Aspergillus fl avus (20.4); Candida albicans (16.3); Candida parapsilosis (14.3); and A s p e rgillus niger (12.2). A combination of two agents was found in five cases. These data show that otomycosis is endemic in Ivo ry Coast. Manage m e n t of otomycosis must include mycological examination for diagnosis as well as changing behavior patterns leading to infection

Two Cases of Chronic Otitis Media caused by Aspergillus terreus / 대한임상미생물학회지

Fungi have been recognized as a significant cause of external otitis and it may be the primary pathogen or be part of a mixed infection. In the immunocompromised host, fungus is capable of producing infection in inner ear or middle ear. Otomycoses are most frequently caused by Aspergillus spp. and Candida sap. There are few reports that Aspergillus species other than A. fumigatus, A. niger and f. flavus have caused chronic otitis media. We report two cases of chronic otitis media caused by Aspergillus ferrous in Korea. One case is a 7-year-old girl who had recurrent serous otorrhea and otalgia for 4 years, was reattended otolaryngology clinics with otorrhea of 3 days durations and another is a 6-year-old girl who had serous otorrhea for 2 months and 3 day fever, was attended otolaryngology clinics with them. Microscopic appearance and colony morphology from ear discharge cultures revealed A. ferrous. The infection responded well to topical ketoconazole therapy. This report should help to raise medical personnel's awareness of such human opportunistic fungal ear infections.

A Clinical and Mycological Study of Otomycosis / 대한의진균학회지

BACKGROUND: Because of recent concern about occurrence of otomycosis in otolaryngologic practice, we studied them. OBJECTIVE: The purpose of this study was to investigate clinical and mycological features of otomycosis. METHOD: We evaluated the clinical and mycological aspects of otomycosis in 38 patients from March 1996 to February 1998 in Dongguk University Hospital. RESULTS AND CONCLUSION: Otomycosis showed high incidence in the twenties (23.7%). The ratio of male to female patient was 1:1.5. The seasonal prevalence was highest in autumn. Most common symptoms were otorrhea (39.4%) followed by itching, obstruction sensation, otalgia, and hearing disturbance. The common causative organisms of otomycosis were Aspergillus(A.) niger (36.8%) followed by A. terreus (26.3%), A. flavus (21.1%), A. fumigatus (7.9%), Candida albicans (5.3%), and Mucor sp. (2.6%).

A Mycological and Epidemiological Study of Otomycosis / 대한피부과학회지

As increasing numbers of antibiotics, adrenocorticosteroids, and antitumor agents have come into use, so increasing numbars of mycotic diseases have been identified. Qtomycosis, a mycotic infection of the extcrnal ear which is occasionally accompanied by dermatitis of the surrounding skin, is corsidered to be such a disease. While opinion vari.es as to whether otomycosis is caused by a saprophytic or a pathogenic organism, our clinical obs:rvations revealed pathological inflammation of the external auditory canal with profuse fungal elements. During August 1975, l3 specimens of ear wax were taken from patients whv visited the out-patient ENT clinic of this hospital. All patients had had their ears clea,ned at a barber shop prior to visiting the ENT clinic. Because ar cleaning instrumenta (scoops and brushes) are re-used m Korean Sarber shops, 204 of theae in- strum.ent;s were randomly selected from different barber shops and examined. KGH mounts and Lactophenol cot@ten blue stains were used to examine the specimens. Qf the lR ear wax specimens, I2 samples (92. 3%) reveaIed Aspergillus sp. and 1 sample (7. 7%) revealed Penicillium sp. Of the 204 ear cleaning instrumenta tested, l94 colonies grew in culture. Of these cultures, 146 (75. 3 %) were Aspergillus sp., 9 (4. 6%) were Mycelia sterila, 5 (2. 6%) were Fenicillium sp., 4 (2. 1 %) wr Al- terna,ria, 2 (l. 0%) were Stemphylium sp., 1 (0. 5%) was Geotrichum sp., and 27 (13. 9%) were of an unknown species. Of the 146 Aspergillius sp. cultures, 99 (67. 8%) were Asp. terreus, 17 (11.6%) were Asp. glaucus, 5 (3.4%) were Asp. niger, 17 (11. 6%) were Asp. flavus-oryzRC, R (2. 1 %) Were Asp. versicolor, and 5 (3. 4 %) were athers. Beca.use of the close correlation between the fungi cultivated from ear wax apc imens and those cultured from ea,r cleaning instruments, the authors believe that the ear cleaning instruments used in the barber shops could well have been the primary source of infection. In this study the authors also discuss the probable causative factbrs of otomycosis arrd a review of the literature is presented.