Fungal Necrotizing Otitis Externa: A 14-Year Retrospective Study of Prognostic Factors
Main Article Content
Abstract
Introduction:
Fungal necrotizing otitis externa (FNEO) is a rare but severe infection that predominantly affects immunocompromised individuals, particularly patients with diabetes mellitus. Compared with bacterial necrotizing otitis externa, FNEO is associated with greater diagnostic difficulties, delayed management, and more complex therapeutic strategies, often resulting in poorer outcomes.
Methods:
We conducted a retrospective study including 83 patients with microbiologically confirmed FNEO treated at the Military Hospital of Tunis between 2010 and 2024. Demographic, clinical, microbiological, radiological, therapeutic, and outcome data were collected and analyzed. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors associated with unfavorable outcomes.
Results:
The mean age of patients was 59 years, and 73% had type 2 diabetes mellitus, among whom 63% had poor glycemic control (HbA1c > 8%). Otalgia was present in all patients, facial nerve paralysis in 24%, and vestibular symptoms in 16%. The most frequently isolated fungal pathogens were Candida albicans (45%) and Aspergillus spp. (35%). Computed tomography revealed temporal bone osteitis in 68% of cases and extension to deep cervical spaces in 11%. Surgical intervention was required in 30% of patients, while 5% required admission to the intensive care unit. Overall mortality was 5%, and recurrence at six months was observed in 11% of cases. Multivariate analysis identified poor glycemic control (OR 2.8), facial nerve paralysis (OR 3.9), and deep tissue extension (OR 5.3) as independent predictors of poor prognosis.
Conclusion:
FNEO remains a life-threatening condition with outcomes strongly influenced by uncontrolled diabetes, cranial nerve involvement, and deep anatomical extension. Early diagnosis, strict glycemic control, and a multidisciplinary therapeutic approach are essential to improve patient prognosis. Further prospective studies are needed to optimize management strategies and reduce morbidity and mortality.
Article Details
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