Otomycosis: diagnosis

When polling necessarily pay attention to the time of onset of the disease and the features of the current. It should be clarified in the patient whether he had previously had otitis media of other localization, the periodicity, duration and nature of the exacerbation.

Consider previous treatment (local or general), its effectiveness, whether there was any deterioration. It is necessary to find out whether the patient was treated with antibiotics, glucocorticoids, cytostatic drugs (duration and intensity of treatment), peculiarities of production and living conditions, previous illnesses, allergic anamnesis. In patients with otomycosis, an increase in the frequency of exacerbations, an absence or a negative effect from standard methods of treatment are noted.

Physical examination

With penicillosis, the process is usually localized in the cartilaginous part of the external auditory canal. A moderate infiltration of the skin of the external auditory canal is noted, not leading to its complete closure. The tympanic membrane is hyperemic in most cases, sometimes its surface is hyperemic, there may be protrusions on it, which creates a false impression of the presence of perforation.

Characteristic and specific for penicilliosis of the external ear is a type of pathological discharge, having various shades of yellow color and in some cases reminiscent of earwax. Pathological discharge is found throughout the external auditory canal. Often during examination, dry crusts and films are found.

In aspergillous lesions, the auditory canal is also constricted by the infiltration of the walls, but unlike penicilliosis, skin infiltration is more pronounced in the bone marrow. Almost in all cases, the tympanic membrane is involved in the process, note its infiltration, thickening, the disappearance of the identification marks. In some cases, granulation is detected. Pathological detachable with aspergillosis lesion is more abundant than with penicilliosis and differs in color. In most cases, it is of different shades of gray, sometimes with black dots, can be cholesteatomo- or gray-like, like a soaked newspaper.

In candidal lesions of the external auditory canal, a moderate narrowing of the external auditory canal is noted, more pronounced in the cartilaginous region, and the tympanic membrane is hyperemic. Pathological discharge of a more liquid consistency than with mold mycosis, more often whitish in color and curdled consistency. The process often extends to the skin of the outer ear.

Laboratory research

Fungal infection can be suspected on the basis of data from the otorhinolaryngological examination, but mycological laboratory methods of investigation are of decisive importance. In this case, once obtained negative results do not indicate the absence of a fungal disease, therefore in this situation it is necessary to conduct a repeated study of the pathological discharge. In this case, a single growth of fungi in sowing does not always indicate a fungal lesion.

To collect samples of biological material on a mycological examination, an attic probe or a Folkman spoon is used. The pathological detachable is desirable to collect from the deep sections of the external auditory canal. The pathological material is placed between two degreased sterile slide glasses and microscopized under 100-, 200-, 400-fold magnification. In addition to microscopy of native material, microscopic examination of preparations colored according to Romanovsky-Gimay is carried out. Microscopic examination is considered the most informative and reliable method of identifying the causative agent of the disease.

For mycological diagnosis, the pathological material is sown to elective media (Saburo, Czapeka, etc.). Yeast-like fungi of the genus Candida are determined by the morphological features and character of fermentation of sugars. The sowing of the material is carried out in test tubes, at 9 sowing points, after which the crops are placed in a thermostat at an ambient temperature of 27-30 ° C. After 6-7 days in the presence of fungus, a continuous growth of the pathogen is observed in all sowing points, while in all test tubes a uniform growth of one species of fungi is detected.

Candida albicans fungus is determined by the accelerated method: in 1 ml of human, rabbit or horse serum, the test material, presumably containing Candida fungi, is looped, after which the tube is placed in a thermostat at an ambient temperature of 37 ° C for 24 hours. Test tubes drop on a slide and microscopize the preparation at a 200-fold magnification. If there is a Candida albicans fungus under the microscope, outgrowths from the cell, the so-called sprout tubes, which are characteristic only of this type of fungi, will be clearly visible.

Differential diagnosis of fungal otitis

Thus, the diagnosis of fungal damage to the ear is based on:

• clinical data;
• detection of microscopic structures of fungal structures:
• positive results of crops on elective media.

In addition, clinical blood tests (including HIV infection, hepatitis markers, syphilis), urine, blood glucose levels, immunogram indices must be made.

Differential diagnosis should be carried out with bacterial otitis media, allergic otitis, eczema, neoplasm of the ear and other inflammatory processes of the external and middle ear.

Indications for consultation of other specialists

Consultation of an immunologist for detection and correction of immunodeficient conditions is necessary, consultation of the endocrinologist - for revealing of endocrine pathology, correction of endocrinopathies.

[1], [2], [3], [4], [5], [6], [7], [8]