Fungal Infections Seen In Ent Clinical Practice

Otomycosis

A fungal infection of the external ear canal is called otomycosis. Aspergillus fumigatus is the most frequent cause, followed by Candida and Aspergillus Niger. It is most common in hot, humid settings, followed by temperate zones. It can also affect the mastoid cavities and, in more complex cases, the middle ear. Prolonged topical antibiotic treatment, wearing hearing aids, swimming frequently in contaminated water, ear canal damage, and immunosuppression are risk factors for this illness.

Clinical Features of Otomycosis

Itching is the main clinical manifestation. Otalgia (ear discomfort), auditory fullness, hearing loss, and tinnitus are other symptoms.
Waving conidiophores are the traditional indicator of otomycosis, albeit they are not always seen. It is thought to be frequently associated with otomycosis.

The exterior canal's generalized inflammatory alterations are the more typical observation.There will be a white discharge with blackish spores and irritation of the external auditory canal.

Complications in Otomycosis

A skull-base osteomyelitis (erosion of the skull base) is fungal malignant otitis externa.  It happens when a fungal infection that is not properly treated seeps through microscopic openings in the external ear canal's cartilaginous floor.  This primarily affects the base of the skull, resulting in bone loss and palsies of the cranial nerve.

Management of Otomycosis

Removing risk factors, washing the ears thoroughly, and applying antifungal medications. Topical antifungal medicines, which come in two varieties: non-specific (acetic acid, alcohol, tonic acid, m-cresyl acetate, and gentian) and specific (clotrimazole, miconazole, econazole, nystatin, tolnaftate, potassium sorbate).

Treatment with antifungals falls into four primary categories:
• Analogs of nucleosides; • Azoles; • Polyenes
• Echinocandins
In addition to this, non-specific medications can be administered to help slow the organism's growth and serve as an exfoliant to remove the dermal layer's outer layer, so removing fungal spores from the skin.

Also Read: Keloids, Hypertrophic Scar And Scar Revision

Fungal Disease Of The Paranasal Sinuses

Classification

 Based on the length of the infection and whether it is invasive or non-invasive, fungus diseases that affect the sinuses can be categorized as acute (symptoms present for less than four weeks) or chronic (symptoms lasting for more than twelve weeks).

The presence of fungal hyphae in the mucosa, submucosa, bone, blood vessels, and paranasal sinus nerves is known as invasive fungal illness. Put another way, the fungus is invading the area. Usually, this takes two forms: either invasive Aspergillosis or invasive Mucormycosis.

The term "non-invasive fungal" refers to surface colonization as opposed to invasion of the epithelial tissues. Usually, sinusitis or allergic fungal infections cause them. This allergic reaction might manifest as: • Localized: Also known as a fungus ball in the area. Allergy fungal rhinosinusitis is the term for this condition in general.

Definition Of Paranasal Sinus Fungal Diseases

Fungal Ball: A localized condition also referred to as mycetoma. The ball-like structure is caused by the buildup of fungal hyphae on one side. In this case, the pathogen is typically Aspergillus species. Immunocompromised people can also exhibit it.

Allergic Fungal Sinusitis: People who are atopic usually have this. They may also possess immunocompetence. Dematiaceous species like Curvularia, Alternaria, and Bipolrais are the cause of it. Moreover, a variety of different molds and Aspergillus species can induce this infection.

Acute Invasive Fungal Sinusitis: Fusarium, Candida species, Aspergilla fumigatus (in immunocompromised patients), and mucormycosis are the causes of this condition.

Chronic Invasive Fungal Sinusitis: Aspergillus is the primary cause of this condition. Those with compromised immune systems exhibit this. Individuals with impaired immune systems might get either kind of invasive sinusitis.

One of the causes of chronic granulomatous invasive sinusitis is Aspergillus flavum. Immunocompetent people exhibit it.

Also Read: Navigating the Depths of Laryngeal Trauma and Laryngotracheal Stenosis

Radiological Findings and Treatment 

Fungal Ball: On CT, a hyperdense ball or hyperdense localized area is shown; this is usually found in the sphenoid or maxillary sinuses. Surgical removal is the typical course of treatment.

Allergy to Fungal Rhinosinusitis: Double densities are a particular radiological characteristic. This is a case of heterogeneous sinus opacification, in which the sinus background alternates between light and dark gray. Both medicinal and surgical procedures are used in treatment.

Whether acute or chronic, invasive fungal infections usually exhibit erosions and tissue penetration. Antifungal therapy and surgery are the two forms of treatment. Here, the immunosuppression that is underlying needs to be overcome. If none of this is completed,

Morbidity, mortality, and recurrence rates are all very high.  Invasive sinusitis with chronic granulomatous disease: This condition only manifests as tissue infiltration and bone degradation. The course of treatment is the same as that for invasive fungal sinusitis: medication and surgery.

Also Read: Gene Therapy: A Journey into the Future of Medicine

Oropharyngeal Candidiasis 

Candida (Candidiasis) is the genus of fungi that typically causes this fungal infection of the oral cavity and pharynx.  Oral thrush, also referred to as white thrush, is typically observed in patients.
It is known that oropharyngeal candidiasis (OPC) has three subtypes:
• Pseudomembranous: This condition is characterized by a white, plaque-like lesion covering the palate, tongue, and oropharyngeal mucosa.
• Atrophic: All of the mucus-producing cells in the cavity have atrophy in this situation.
• Hyperplastic candidiasis: The parietal gingivitis tissue's submucosal tissue has hyperplasia.

Oropharyngeal Candidiasis (POC) In HIV Patients

Candida albicans is a typical component of the genitourinary, gastrointestinal, and skin microbiota. Up to 90% of patients had OPC prior to the introduction of antiretroviral medication (ART) for the treatment of HIV.
  Patients with HIV are more likely to develop OPC if their immunity falls below a particular threshold, which is often defined as an absolute CD4+ T-lymphocyte count of less than 200 cells/microlitre.

As candida is a normal flora of the human oral tract, genital tract, vagina, etc., it can also occur in patients with poor immunosuppression, inhalers who do not gargle after inhalation, and patients with dentures who have chronic irritation.

Hope you found this blog helpful for your Basic Sciences Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs. 

Propel your ENT Residency Preparation! Access conceptual video lectures, QBank, Mock Tests, and premium study resources on the PrepLadder App. Download it today!