Otomycosis With Tympanic Membrane Perforation: A Review of the Literature.

OBJECTIVE: The purpose of the present study was to assess the rate of tympanic membrane perforation in patients with otomycosis and to discuss the literature regarding the difficulties in managing this condition. DATA SOURCES: Literature review from 1999 to 2019, Web of Science, PubMed, and Medline. STUDY SELECTION: We searched for eligible articles concerning the clinical entity of tympanic membrane perforation secondary to otomycosis. Case series and clinical trials were the types of articles included for this review. DATA EXTRACTION: All the articles described in the study selection were used for this review. DATA SYNTHESIS: Statistical techniques were not used. CONCLUSION: Based on the available literature, it seems that tympanic membrane perforation secondary to otomycosis is not uncommon. The presence of this complication is associated with 2 problems: Antimycotic solutions are irritant to middle ear and may be ototoxic to the cochlea. Although most cases of fungus caused tympanic membrane (TM) perforation resolve with proper medical treatment, in a few patients a tympanoplasty may be required.

Fungal otitis externa as a cause of tympanic membrane perforation: a case series.

We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.