FEATURES OF MYCOLOGICAL AND CLINICAL STUDIES OF OTOMYCOSIS

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Abstract

The results of our studies made it possible to determine the main pathogenetic factors in the development of otomycosis in the examined patients, which is especially important; since fungi - causative agents of otomycosis are conditionally pathogenic microorganisms and show their pathogenic properties only under certain conditions. We found that an important factor for the development of otomycosis is the presence of general somatic diseases, which, according to the present study, were present in the majority (70.1%) of patients, which indicates a decrease in the body's resistance to opportunistic flora against the background of chronic diseases, various metabolic disorders. 25.7% of patients had diseases of the gastrointestinal tract, in which dysbiosis develops with a decrease in the proportion of obligate microflora, a decrease in natural resistance to fungal flora. Diseases of the cardiovascular system of varying severity, including myocardial infarction, were found in 23.45% of patients. The fact that in 32 patients otomycosis developed against the background of diabetes mellitus testifies in favor of the pathogenetic significance of carbohydrate metabolism disorders in the development of mycosis. A small number of observations and the results obtained did not allow us to state with certainty that there is a direct relationship between the incidence of otomycosis and antibiotic therapy. Analysis of our clinical material showed that prior to the diagnosis of otomycosis, systemic antibiotic therapy according to the anamnesis was carried out in 20 patients, local - in 9 patients (a total of 29 patients - 7.1% of the number of patients with otomycosis). We found that traumatic factors in the form of a systematic toilet of the ear canal with a cotton swab, removal of sulfuric plug, use of endoural headphones play an important role in the development of fungal ear infections. Against the background of trauma, otomycosis developed in 56.5% of patients.


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Publisher:

The USA Journals

ABSTRACT

The results of our studies made it possible to determine the main pathogenetic factors in the development of
otomycosis in the examined patients, which is especially important; since fungi - causative agents of otomycosis are
conditionally pathogenic microorganisms and show their pathogenic properties only under certain conditions. We
found that an important factor for the development of otomycosis is the presence of general somatic diseases, which,
according to the present study, were present in the majority (70.1%) of patients, which indicates a decrease in the
div's resistance to opportunistic flora against the background of chronic diseases, various metabolic disorders. 25.7%
of patients had diseases of the gastrointestinal tract, in which dysbiosis develops with a decrease in the proportion of
obligate microflora, a decrease in natural resistance to fungal flora. Diseases of the cardiovascular system of varying
severity, including myocardial infarction, were found in 23.45% of patients. The fact that in 32 patients otomycosis
developed against the background of diabetes mellitus testifies in favor of the pathogenetic significance of
carbohydrate metabolism disorders in the development of mycosis. A small number of observations and the results
obtained did not allow us to state with certainty that there is a direct relationship between the incidence of otomycosis

Research Article


FEATURES OF MYCOLOGICAL AND CLINICAL STUDIES OF
OTOMYCOSIS

Submission Date:

January 09, 2022,

Accepted Date:

January 19, 2022,

Published Date:

January 29, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue01-06


Ulugbek S. Khasanov

DSc, professor, department of Otorhinolaryngology and stomatology,Tashkent Medical Academy,
Uzbekistan

Shokhimardon K. Khudjanov

PhD, associate professor, department of Otorhinolaryngology and stomatology, Tashkent Medical
Academy, Uzbekistan

Jamolbek A. Djuraev

DSc, associate professor, department of Otorhinolaryngology and stomatology, Tashkent Medical
Academy, Uzbekistan

Abdurasul J. Botirov

PhD, senior teacher, department of Otorhinolaryngology and stomatology, Tashkent Medical Academy,
Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


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VOLUME

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SJIF

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Publisher:

The USA Journals

and antibiotic therapy. Analysis of our clinical material showed that prior to the diagnosis of otomycosis, systemic
antibiotic therapy according to the anamnesis was carried out in 20 patients, local - in 9 patients (a total of 29 patients
- 7.1% of the number of patients with otomycosis).

We found that traumatic factors in the form of a systematic toilet of the ear canal with a cotton swab, removal of
sulfuric plug, use of endoural headphones play an important role in the development of fungal ear infections. Against
the background of trauma, otomycosis developed in 56.5% of patients.

KEYWORDS

Otomycosis, ear, pain, otitis media.

INTRODUCTION

In recent years, mycoses with their diverse localization
and clinical manifestations have been studied in depth
by doctors of various specialties. Thus, according to
WHO data, 20% of the world's population, i.e. every
fifth inhabitant of the planet is affected by a fungal
infection [1]. The wide distribution of fungi in nature,
their constant presence, both in the environment and
in the div, makes it inevitable that contacts and
infection of a person are inevitable. Currently, there is
an increase in the number of patients with mycotic
lesions of the ENT organs and, in particular, the outer
and middle ear, including postoperative cavities of the
middle ear. The increase in the number of patients is
due to both a significant increase in risk factors for the
development

of

mycosis,

and

unsystematic

uncontrolled use of local antibacterial drugs in the
treatment of otitis media. In addition, there is a trend
towards the development of resistance of the mycosis
fungus to specific antifungal drugs [2]. An increase in
the proportion of chronic fungal inflammation with
frequent relapses that are not amenable to drug
correction has been noted, which, in turn, leads to an

increase in the period of disability and disability of the
population [3].

An increase in fungal diseases among the population
and an increase in the number of fungal lesions of the
skin and mucous membranes is an urgent problem for
modern medical mycology [4]. The number of patients
hospitalized for fungal diseases of the upper
respiratory tract increases annually.

Otomycosis, a fungal infection of the ear, is a
widespread disease. The proportion of otomycosis
among inflammatory diseases of the ear is up to 18% in
adults and up to 26.3% in children. According to 50% of
all mycoses of ENT organs is otomycosis.

The high prevalence of otomycosis among the
population, the lack of effectiveness of treatment and
the very frequent occurrence of relapses of the disease
makes it necessary to look for new optimal means and
methods for the treatment of otomycosis [5].

Among the methods of treatment, the local treatment
of otomycosis is of the greatest importance. At the


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same time, the choice of a method for delivering a
medicinal substance to the focus of pathology is a
decisive moment for the successful treatment of the
disease. For the treatment of diseases of the outer ear,
various methods of delivering drugs to the
pathological focus are traditionally used by the
introduction of solutions and ointments, by
electrophoresis, transportation of the drug together
with dimethyl sulfoxide and laser photochemotherapy
[6].

In recent years, a number of authors consider the use
of immobilized drugs of prolonged action to be
promising for local therapy of various diseases. The use
of these drugs can reduce the toxicity of drugs,
reduces the likelihood of allergic reactions and the
severity of side effects, and also reduces the dose of
drugs. The use of gelatin films for treatment makes it
possible to deliver the medicinal substance directly to
the focus of the pathology or as close as possible to it,
the medicinal substance is released in a given place,
which makes it possible to increase the effectiveness
of treatment [7-11].

Despite the currently available research on the
diagnosis and treatment of otomycosis [11], a number
of theoretical and practical issues of this problem
remain unexplored. These include the lack of optimal
means for the treatment of otomycosis and methods
for delivering drugs to the focus of pathology. The
microbiological features of the microflora of the upper
respiratory tract and the outer ear in the conditions of
the North have not been studied [12-14]. The
effectiveness of the use of gelatin films in the
treatment of otomycosis has not been determined.
Possibilities of local treatment of the disease are
insufficiently used. The systematic analysis of the
diagnosis and treatment of otomycosis with gelatin

films has not been sufficiently implemented, which
makes it difficult to prevent and treat otomycosis.

Material and methods. As a result of an eight-year
observation period in the provision of specialized
medical care on the basis of a multidisciplinary TMA
clinic, 68 patients with inflammatory ear diseases were
diagnosed with otomycosis, which were included in
this work.

All patients underwent a general clinical examination:
clarification of complaints, collection of an anamnesis
of the disease and life, a general blood test, a general
urine test. An otorhinolaryngological examination was
carried out: external examination of the ENT organs,
rhinoscopy, pharyngolaryngoscopy, otoscopy using an
ear funnel, using a magnifying technique (Ziegle
funnel, otoscope, operating microscope). The study of
hearing included checking the perception of whispered
and colloquial speech, if necessary, a tuning fork study
was

performed

(appointed),

tone

threshold

audiometry.

RESULTS AND DISCUSSION

When interviewing patients with otomycosis, the
nature of complaints, the duration of the disease,
concomitant diseases, risk factors, previous episodes
of treatment and the effectiveness of treatment, as
well as an anamnesis of life and profession, were
ascertained.

During the initial treatment, the patients presented
various complaints, the nature of the complaints and
their number changed during the treatment.
Complaints of patients with otomycosis during the
initial examination are presented in Table 1.

Table 1


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Table 1

Complaints of patients with otomycosis during the initial examination.

Indicator

Total

%

Number of persons

of them complained about:

68

100

Itching in the ear

34

50

Feeling of stuffy ear

32

45,5

Ear pain

28

41,2

Ear discharge

20

29,4

Discomfort in the ear

11

16,2

Hearing loss

7

10,3

Feeling of moisture in the ear

3

4,4

Noise in the ear

3

4,4

Increase in div temperature

2

2,9

From Table 1 it follows that the main complaints of
patients were complaints of itching in the ear - 50%, a
feeling of stuffiness in the ear - 45.5%, pain in the ear -
41.2%, discharge from the ear - 29.4%, which
corresponds to the literature data. .

In order to detail the complaints, the complaints of
patients with acute, chronic otomycosis during and
without exacerbation of otomycosis were analyzed
separately. Complaints of patients with otomycosis in
acute and chronic course of the disease are presented
in table 2.

Table 2

Complaints of patients with otomycosis in acute and chronic course of the disease

Indicator

Acute otomycosis

Chronic otomycosis,

exacerbation

Chronic otomycosis,

without exacerbation


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Абс.

%

Абс.

%

Абс.

%

Number of

persons

of them

complained

about:

20

19

29

Itching in the

ear

9

45

8

42,1

17

58,6

Feeling of

stuffy ear

7

35

12

63,2

12

41,4

Ear pain

10

50

12

63,2

6

20,7

Ear discharge

6

30

10

52,6

4

13,8

Discomfort in

the ear

2

10

2

10,5

7

24,1

Hearing loss

4

20

1

5,3

2

6,8

Feeling of

moisture in

the ear

3

10,3

Noise in the

ear

2

10

1

5,3

Increase in

div

temperature

1

5

1

5,3

From Table 2, it follows that in patients with acute
otomycosis, the first place is for complaints of pain in
the ear (50.0%), the second place is for complaints of
itching in the ear (45.0%), and the third place is for
complaints of a feeling of congestion in the ear (
35.0%). For patients with chronic otomycosis during

exacerbation, in the first place, complaints of pain in
the ear and a feeling of congestion in the ear (63.2%), in
the second place, complaints of discharge from the ear
(52.6%), and in the third place, complaints of itching in
the ear ( 42.1%). In patients with chronic otomycosis
without exacerbation, in the first place were


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Publisher:

The USA Journals

complaints of itching in the ear (58.6%o), in the second
place were complaints of a feeling of stuffiness in the
ear (41.4%), in the third place were complaints of
discomfort in the ear (24.1% ).

In order to determine the diagnostic significance of
complaints in various forms of the course of

otomycosis, the complaints of patients with acute
otomycosis, chronic otomycosis during exacerbation,
and chronic otomycosis without exacerbation were
analyzed separately. The diagnostic significance of
complaints of patients with acute otomycosis is
presented in Table 3.

Table 3

Diagnostic significance of complaints of patients with acute otomycosis

Indicator

healthy,

n=30

Acute otomycosis,

n=20

DC

I

Abs.

%

Abs.

%

Number of

persons

of them

complained

about:

30

20

Itching in the ear

1

3,3

9

45

11

1,7

Feeling of stuffy

ear

7

35

10

1,3

Ear pain

10

50

11

2

Ear discharge

6

30

10

0,6

Discomfort in the

ear

1

3,3

2

10

5

0,2

Hearing loss

4

20

8

0,3

Feeling of

moisture in the

ear

2

0,2

Noise in the ear

2

10

5

0,2


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Publisher:

The USA Journals

Increase in div

temperature

1

5

2

0,2

Note: * - sufficient information content of indicators at 1 min = 0.5.

From Table 3 it follows that the most significant
diagnostic coefficient in acute otomycosis had
complaints of patients with itching (DK=11) and pain in
the ear (DK=11), in second place were complaints of a
feeling of congestion in the ear (DK=10) and discharge

from the ear (DK=10) and in third place were
complaints of hearing loss (DK=18).

The diagnostic significance of complaints of patients
with exacerbation of chronic otomycosis is presented
in Table 4.

Table 4.

Diagnostic significance of complaints of patients with exacerbation of chronic otomycosis

Indicator

Healthy,

n=30

Chronic

otomycosis,

exacerbation,

n=19

DC

Abs.

%

Abs.

%

Number of

persons

of them

complained

about:

30

19

Itching in the

ear

1

3,3

8

42,1

11

Feeling of

stuffy ear

12

63,2

13


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OCLC

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Publisher:

The USA Journals

Ear pain

12

63,2

13

Ear discharge

10

52,6

12

Discomfort in

the ear

1

3,3

2

10,5

6

Hearing loss

1

5,3

2

Feeling of

moisture in

the ear

2

Noise in the

ear

1

5,3

2

Increase in

div

temperature

1

5,3

2

From Table 4 it follows that the most significant
diagnostic coefficient in exacerbation of chronic
otomycosis had complaints of patients about a feeling
of stuffiness in the ear and pain in the ear (DK=13), in
second place were complaints of discharge from the

ear (DK=12) and in third place were complaints of
itching in the ear (DK=11). The diagnostic significance of
complaints of patients with chronic otomycosis
without exacerbation is presented in Table 5.

Table 5.

Diagnostic significance of complaints of patients with chronic otomycosis without exacerbation

Indicator

Healthy, n=30

Chronic otomycosis,

without exacerbation,

n=29

DC

Abs.

%

Abs.

%

Number, people of them

complained about:

30

100

29


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Publisher:

The USA Journals

Itching in the ear

1

3,3

17

58,6

13

Feeling of stuffy ear

12

41,4

11

Ear pain

6

20,7

8

Ear discharge

4

13,8

6

Discomfort in the ear

1

3,3

7

24,1

9

Hearing loss

2

6,8

3

Feeling of moisture in the

ear

3

10,3

5

Noise in the ear

Increase in div

temperature

From table 5 it follows that the most significant
diagnostic coefficient for chronic otomycosis without
exacerbation had complaints of patients with itching in
the ear (DK=13), in second place were complaints of a
feeling of stuffiness in the ear (DK=11) and in third place
were complaints of discomfort in the ear (DK=9).

If we group the main complaints regarding the nature
of the course of otomycosis, then we can conclude that
complaints of pain in the ear prevail in acute
otomycosis (DK = 11) and exacerbation of the chronic
process (DK = 13), complaints of itching in the ear are
leading in patients with chronic otomycosis without
exacerbation

(DK=13).

Complaints

about

ear

congestion are equal in frequency to complaints of
pain in the ear during an exacerbation of a chronic
process (63% of patients, DC=13), in contrast to
complaints in acute otomycosis, for which complaints
of ear congestion are less common (35% of patients,
DC=10 ), which may indirectly indicate their specificity

for the exacerbation of chronic mycotic processes in
the ear.

A separate group of complaints consisted of
complaints of discomfort in the ear and a feeling of
moisture in the ear. Complaints of discomfort in the ear
occurred in 24.1% of cases in patients with chronic
otomycosis without exacerbation (DC=9), which is two
times more common than in patients with acute and
exacerbation of chronic otomycosis (10.0 and 10.5%
each). , DC=5 and 6, respectively). Patients with chronic
otomycosis without exacerbation complained about
the feeling of moisture in the ear (10.3% of patients,
DK=5), and it was not present in groups with acute and
exacerbation of chronic otomycosis (DK=2), which
makes this complaint rather specific.

Indicators of the diagnostic coefficient and
informativeness

of

complaints

and

clinical


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manifestations in patients with otomycosis are
presented in Table 6.

Table 6

Indicators of the diagnostic coefficient (DC) and information content (I) of signs of otomycosis

Complaints

Acute otomycosis

Exacerbation of chronic

otomycosis

Chronic otomycosis

without exacerbation

DC

I*

DC

I*

DC

I*

Itching in the ear

11

1,7

11

1,7

13

1,8

Feeling of stuffy

ear

10

1,3

13

1,6

11

1,3

Ear pain

11

2,0

13

2,1

8

0,6

Ear discharge

10

0,6

12

0,6

6

0,5

Note: * - sufficient information content of indicators at I min = 0.5.

From table 6 it follows that complaints of itching in the
ear, a feeling of stuffiness in the ear and pain in the ear
are the most informative (I=0.6-2.0), clinical
manifestations in the form of discharge from the ear
are less informative (I=0.5- 0.6).

In 180 patients, the causative agent of the fungal
disease was mold fungi. Pathological discharge in the
external auditory canal of the affected ear was present
in all patients. At the same time, the nature of the
pathological secretion depended on the type of
pathogen fungus. So in 83 patients, the discharge had

a caseous character with black patches, resembling a
“wet newspaper” (Fig. 3.1). A purulent-caseous plug in
the bone part of the external auditory canal with air
filaments of mycelium, which made it possible to
diagnose a fungal disease without waiting for the
results of sowing, was noted by us in 79 patients (Fig.
3.2). After removal of caseous masses, damaged skin
was exposed, mainly in the bone part of the ear canal
with flaccid granulation tissue. In 10 patients
(pathogens were fungi of the genus Renicillhim), the
discharge in the external auditory canal was dark
yellow, with brown inclusions.


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Figure 3.1. Fungal otitis externa. Caseous discharge with black patches in the external auditory canal.

Otomicroscopy. magnification x 16. Pathogen - Aspergillus niger.

Figure 3.2. Fungal otitis externa. Purulent-caseous film with aerial mycelium. Otomicroscopy. magnification

x 24. Pathogen - Rhizomucor spp.

Infection by Aspergillus fungi, detected in 162 patients
(57.85%), was accompanied by complaints of ear pain,
discharge of a different nature. On examination, a
“fungal div” was visualized in the bony part of the
external auditory canal. The tympanic membrane was
hyperemic in 109 patients, injected with blood vessels

in 42. Shortening of the light reflex was observed in 172
patients. In 6 patients, the fungal process was localized
only on the eardrum. After removal of the fungal div
from the tympanic membrane, granulation tissue was
exposed, the tympanic membrane was hyperemic, and
there was no light reflex. In another 12 patients, against


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the background of severe infiltration of the skin of the
external auditory canal, accompanied by a narrowing
of its lumen to 2/3 or more, during examination, we did
not detect elements of the fungal div, but only
separate films of the pathological discharge, but with
microscopy of the native preparation and in the
sowing, molds were determined. mushrooms.

In patients with candidiasis of the skin of the external
auditory canal - 100 people - pathological cheesy
discharge in the external auditory canal was present in
53 patients. Eczematous changes in the skin of the
external auditory canal were noted in all patients. The
tympanic membrane was intact in 89 patients, and only
in 11 patients, after the removal of mycotic masses, its
hyperemia was noted. In 2 patients, the tympanic
membrane was infiltrated.

Clinical and mycological studies carried out by us made
it possible to establish the diagnosis of fungal otitis
externa in 280 patients.

All patients, regardless of the type of fungal infection,
underwent a complex of laboratory tests. The result is
presented in table 6. It was found that in 180 patients
the pathogens of the process were various mold fungi.
The bulk is represented by the species A. niger—133
observations, in 21 patients the fungus A. fumigatus
was identified as the causative agent, in 8 patients

other types of aspergillus were identified. In 10
patients, the pathogens were fungi of the genus
Penicillium, in 6 patients - fungi of the genus Mycor.

In 100 patients, the causative agents of the fungal
disease were yeast-like fungi of the genus Candida. In
21 patients, the causative agent of the inflammatory
process was the fungus Candida albicans, in 17 patients
- Candida tropicalis, in 6 patients - Candida sake. The
causative agents of other species of Candida were less
common. Further, in descending order, pathogens
detected with the same frequency are presented. So,
Candida krusei and Candida parapsilos is detected in 5
patients; Candida pseudotropicalis and Candida
glabrata - in 3 patients; Candida hellermanii, Candida
ciferrii, Candida dubliniensis - in 2 patients; Candida
famata, Candida globosa, Candida curvata, Candida
intermedia - each in 1 patient. In 30 patients, other
albicans strains of fungi of the genus Candida were
isolated.

15 patients had a combined infection with mold and
yeast-like fungi. At the same time, A. niger accounted
for 13 cases and A. fumigatus - 2 cases. Among fungi of
the genus Candida, the species albicans (12
observations) was more common in the association
than krusei (3 observations). The results obtained are
presented in table 7.

Table 7

Causative agents of fungal external otitis.

Pathogen

Total

Aspergillus

Niger

13

57,8%

Fumigatus

7

Spp.

1


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Penicillium spp.

5

Mucor spp.

2

Rhizomucor spp.

1

Whole filamentous mushrooms

24 (67,5%)

Candida

С. albicans

14

С. tropicalis

9

С. sake

6

С. krusei

1

С. parapsilosis

5

С.pseudotropicalis

1

С. glabrata

3

С. hellermanii

2

С. ciferrii

1

С. dubliniensis

1

С. famata

1

С. globosa

1

С. curvata

1

С. intermedia

2

Candida spp.

1

Total yeast-like fungi

6

Total

68

Note: * Mushrooms included in associations are marked.


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Thus, the main causative agents of fungal otitis externa
are fungi found in 180 patients (64.3%), while the genus
Aspergillus accounted for 162 observations (57.85%).
Yeast-like fungi were identified as an etiological factor
in 100 observations (35.7%), while the most pathogenic
fungus Candida albicans was identified only in 21
patients. The second most important species is
Candida tropicalis, isolated from 17 patients with
external fungal otitis.

In all 72 patients examined by us with fungal otitis
media, the main complaints were discharge from the
patient yxa and hearing loss (100%). All fungal lesions of
the middle ear (accompanied by suppuration.
Discharges were mainly: liquid with (candidiasis and
thicker with mold mycosis. Pain in the affected; ear
bothered 69 patients (95.8%), headache on the side of
the affected ear was noted only by 62 patients (86.l%)
itching in the diseased ear periodically occurred in 54
patients (75%) during the period of regression-fungal
process and was paroxysmal in nature. ; in 53 patients.
19 patients described the noise as low-frequency (hum,
the sound of the surf). The feeling of fullness,
"bursting" in the ear bothered 57 patients.

Complaints of dizziness, which is non-systemic, were
presented by 28 patients.

When comparing the complaints of patients with
external fungal otitis media and fungal otitis media, it
can be concluded that with otitis media, hearing loss,
noise, ear pain bothered almost all patients. Dizziness
was noted in 1/3 of patients, while with external fungal
otitis it occurred only in 3%. These significant
differences are important in diagnosing the
localization of mycosis.

The tympanic membrane was perforated in all patients,
while in 67 the perforation was located in the tense
part (in 23 in the lower sections, in 19 in the upper, in 25

there was a subtotal or total defect), and in 5 patients
there was a fistulous tract in the attic.

On examination, various changes in the skin of the ear
canal and mucous membrane of the middle ear were
noted.

48 patients had a pronounced edema and infiltration of
the skin of the external auditory canal, while the
narrowing of the lumen by 1/3 was present in 23
patients, up to 2/3 - in 13 patients, complete narrowing
- in 12 patients. A more significant narrowing of the
lumen was with mold mycosis. In 24 patients,
narrowing of the lumen of the auditory canal was not
observed, however, eczematous skin changes were
more pronounced. These clinical observations indicate
that the fungal lesion of the middle ear was combined
in these patients with a fungal lesion of the external
auditory canal.

In 57 patients with otitis media, the causative agent of
the fungal disease was yeast-like fungi of the genus
Candida. Abundant purulent discharge in large
quantities (soaking up to 8 "quilted jackets") was not
only in the tympanic cavity, but also in the external
auditory canal. The viscosity of pus varied from thick to
liquid, the consistency was often homogeneous.

In 15 patients, the causative agent of otitis was
filamentous fungi. Pathological discharge in the
auditory canal of the affected ear, spreading through
the perforation of the tympanic membrane into the
cavity of the middle ear, was present in all patients and
depended on the type of fungus - pathogen. So,
discharge of the type of "wet newspaper" - caseous in
nature with black patches (Fig. 3), was observed in 9
patients with aspergillosis. A purulent-caseous plug in
the bone part of the auditory canal with air filaments1
of the mycelium (like a cotton ball) (Fig. 4) was noted
by us in 2 patients. Upon removal of caseous masses,


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hyperemia and infiltration of the skin in the bone part
of the auditory canal, tympanic membrane, mucous
membrane of the tympanic cavity were revealed,
flaccid granulation tissue was exposed. In 4 more
patients with aspergillosis, during examination, we
detected only granulation tissue along the edge of the
perforation of the tympanic membrane, membrane,
and only with microscopy of the native preparation and
sowing of pus, the presence of mold fungi was
determined.

An audiological examination revealed a decrease in
hearing in the diseased ear in all patients due to
impaired sound conduction, which was caused by
perforation of the tympanic membrane. Hearing loss

varied from the first to the fourth degree (according to
V.G. Ermolaev, A.L. Levin). However, 19 patients had
hearing loss in the diseased ear due to sound
perception. The degree of increase in thresholds for
bone conduction varied from the third to the fourth.

All patients, regardless of the type of fungal infection,
underwent a complex of laboratory tests.

The result of mycological studies is presented in Table
8. It was found that in fungal otitis media, yeast-like
fungi of the genus Candida dominated, identified in
79.2% of cases, in second place were filamentous fungi
of the genus Aspergillus (20.8%).

Table 8

Causative agents of fungal otitis media.

Pathogen

Total

Candida

С. albicans

14

С. krusei

8

С. sake

3

С.pseudotropicalis

1

С. parapsilosis

4

C.tropicalis

1

С. Hellermanii

1

С. glabrata

2

C.famata

1

Candida spp.

1

Aspergillus niger

4


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Aspergillus fumigates

1

Aspergillus spp.

2

Mucor spp.

1

Total

29

Among 57 patients in whom the causative agents of
the fungal disease were yeast-like fungi of the genus
Candida, the fungus C. albicans was in the first place in
terms of frequency of detection (14 patients). Then, in
descending order, follow C. krusei - (13 patients), C.
sake (7 patients), C. pseudotropicalis (5 patients), C.
parapsilosis (3 patients), C. tropicalis and C. hellermanii
(2 patients each) , C. glabrata and C. famata (1 patient
each). Other non-albicans strains of fungi of the genus
Candida were isolated from 9 patients.

15 patients with the causative agent of otitis had
various mold fungi. The main mass is represented by
fungi of the species A. niger - 10 observations, in 2 more
patients the causative agent of the inflammatory
process was the fungus A. fumigatus, in 2 more
patients other types of aspergillus were detected. In 1
patient, as a result of the study, a fungus of the Mycor
genus was detected.

All 53 patients had colored discharge from the ear
(100%). The nature of the secretions varied from liquid
and thick to dry (crusts, films). Pain in the affected ear
bothered 50 patients (94.3%), only 42 of them (86.1%)
reported headache on the side of the affected ear.
Itching in the diseased ear periodically occurred in 40
patients (75%) during the regression of the fungal
process and was paroxysmal in nature.

The noise in the affected ear bothered all patients, and
more often could be attributed to low-frequency in the
form of a hum, surf noise (noted in 34 patients) or high-
frequency, described as a mosquito squeak, ringing (19
patients).

27 patients complained of a feeling of fullness,
"bursting", heaviness in the operated ear. Dizziness,
which is non-systemic in nature, bothered 25 patients
(47.16%). This is undoubtedly a very important sign,
since such a frequent complaint, apparently, may be
the result of mycotic intoxication and should especially
alert doctors to a more in-depth examination of the
vestibular function in this group of patients. All these
data are reflected in table 22.

On examination, it was revealed that the postoperative
cavity in almost all 47 patients with aspergillosis was
filled with caseous masses resembling a “wet
newspaper”, in 38 cases aerial mycelium with ripe
conidia was found (Fig. 3.3). In 3 patients, the fungal
div in the postoperative cavity resembled a ball of
cotton wool (Fig. 3.4).

The postoperative cavity in patients with candidiasis
was filled with thick pus of heterogeneous consistency
with whitish inclusions..


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Figure 3.3. Mycosis of the postoperative cavity. Caseous crust with aerial mycelium with mature conidia.

Endoscopy, magnification x 40. Pathogen - Aspergillus niger.

Figure 3.4. Mycosis of the postoperative cavity. Detachable by the type of "piece of cotton wool".

Otomicroscopy. magnification x 8. Pathogen - Aspergillus niger.

Upon removal of the purulent caseous discharge,
bleeding

granulation

tissue

was

exposed.

Epithelialization of the postoperative cavity was
incomplete. The largest amount of granulation tissue
was observed behind the "spur".

We have noted that fungal infection of the
postoperative cavities of the middle ear develops in
patients who underwent radical general cavity surgery.
Sanitizing operation on the middle ear with
tympanoplasty is complicated by the development of
mycosis 2 times less often.


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Thus, in our opinion, some help in clarifying the
localization of the process can be provided by the
presence of such signs as headache on the side of the
lesion, a feeling of fullness, dizziness and the nature of
the noise, the frequency of which varies significantly in
fungal external or otitis media.

We found that in fungal lesions of postoperative
cavities of the middle tract, mold fungi were the
predominant pathogens, the proportion of which was
94.3% of the total number of patients with this
pathology (Table 9).

Table 9

Mycological characteristics of fungal postoperative otitis.

Pathogen

Total

Aspergillus niger

7

Aspergillus fumigates

3

Aspergillus spp.

2

Mucor spp.

1

Rhizomucor spp.

2

Candida albicans

3

Candida spp.

2

Total

14

At the same time, fungi of the genus Aspergillus,
isolated in 88.67% of cases from all patients, turned out
to be the most pathogenic, and only 5.66% accounted
for fungi of the genus Candida. These results - the
dominance of mold fungi in this pathology - can be
sufficiently

convincing

when

considering

the

pathogenesis of otomycosis of this localization. Some
authors believed that fungal postoperative otitis is
diagnosed in the vast majority of patients with
unrecognized fungal otitis media before surgery. But
the results of our mycological studies do not confirm
this, since significant differences were found among

the fungi of the causative agents of the disease in otitis
media and mycosis of the postoperative cavity.

The fact that molds dominate in mycosis of the
postoperative cavities of the middle ear, which we
have established, must be taken into account when
prescribing treatment, since all molds have a natural
resistance to fluconazole.


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CONCLUSION

The results of our studies made it possible to
determine the main pathogenetic factors in the
development of otomycosis in the examined patients,
which is especially important; since fungi - causative
agents of otomycosis are conditionally pathogenic
microorganisms and show their pathogenic properties
only under certain conditions.

We found that an important factor for the
development of otomycosis is the presence of general
somatic diseases, which, according to the present
study, were present in the majority (70.1%) of patients,
which indicates a decrease in the div's resistance to
opportunistic flora against the background of chronic
diseases, various metabolic disorders. 25.7% of patients
had diseases of the gastrointestinal tract, in which
dysbiosis develops with a decrease in the proportion of
obligate microflora, a decrease in natural resistance to
fungal flora. Diseases of the cardiovascular system of
varying severity, including myocardial infarction, were
found in 23.45% of patients. The fact that in 32 patients
otomycosis developed against the background of
diabetes mellitus testifies in favor of the pathogenetic
significance of carbohydrate metabolism disorders in
the development of mycosis. A small number of
observations and the results obtained did not allow us
to state with certainty that there is a direct relationship
between the incidence of otomycosis and antibiotic
therapy. Analysis of our clinical material showed that
prior to the diagnosis of otomycosis, systemic
antibiotic therapy according to the anamnesis was
carried out in 20 patients, local - in 9 patients (a total of
29 patients - 7.1% of the number of patients with
otomycosis).

The data of many studies also indicate the presence of
a direct relationship between the development of
superficial and systemic mycosis in patients and long-

term (for three or more weeks) corticosteroid therapy
at doses exceeding 0.5-1 mg / kg / day in terms of
prednisone. Our study showed that local treatment
with corticosteroids preceded the development of
otomycosis in only 9 patients (2.22% of the total
number of patients with otomycosis). We do not deny
that corticosteroids can play the role of a risk factor for
the development of mycosis, however, a small number
of patients examined by us who received long-term
systemic high-dose hormonal therapy in our study does
not allow us to conclude that this factor has a
significant effect on the development of fungal ear
infections.

We found that traumatic factors in the form of a
systematic toilet of the ear canal with a cotton swab,
removal of sulfuric plug, use of endoural headphones
play an important role in the development of fungal ear
infections. Against the background of trauma,
otomycosis developed in 56.5% of patients.

Thus, in the pathogenesis of fungal diseases of the ear,
a wide variety of factors of endogenous and
exogenous nature are important: various general
somatic diseases that violate the protective
mechanisms and reactions of the div, chronic
inflammation. The dominant role of traumatic factors
is clearly revealed. Against the background of trauma,
otomycosis developed in 56.5% of patients.

REFERENCES

1.

Abastabar M. et al. Candida auris otomycosis in
Iran and review of recent literature //Mycoses. –
2019. – Т. 62. – №. 2. – С. 101-105.

2.

Safari F. et al. A Chronic Autochthonous Fifth
Clade Case of Candida auris Otomycosis in Iran
//Mycopathologia. – 2021. – С. 1-7.

3.

Ali K. et al. Identification of fungal pathogens in
otomycosis and their drug sensitivity: our


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SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

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experience

//International

archives

of

otorhinolaryngology. – 2018. – Т. 22. – №. 04. – С.
400-403.

4.

Kiakojori K. et al. Assessment of response to
treatment in patients with otomycosis //Iranian
Journal of Otorhinolaryngology. – 2018. – Т. 30. –
№. 96. – С. 41.

5.

Carney A. S. Otitis externa and otomycosis //Scott-
Brown’s Otorhinolaryngology Head and Neck
Surgery. – CRC Press, 2018. – С. 953-958.

6.

Dundar R., İynen İ. Single dose topical application
of clotrimazole for the treatment of otomycosis: is
this enough? //Journal of audiology & otology. –
2019. – Т. 23. – №. 1. – С. 15.

7.

Li Y., He L. Diagnosis and treatment of otomycosis
in southern China //Mycoses. – 2019. – Т. 62. – №.
11. – С. 1064-1068.

8.

Koltsidopoulos P., Skoulakis C. Otomycosis with
tympanic membrane perforation: a review of the
literature //Ear, Nose & Throat Journal. – 2020. – Т.
99. – №. 8. – С. 518-521.

9.

Aboutalebian S. et al. Molecular epidemiology of
otomycosis in Isfahan revealed a large diversity in
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agents

//Journal

of

medical

microbiology. – 2019. – Т. 68. – №. 6. – С. 918-923.

10.

Jimenez-Garcia L. et al. Efficacy of topical
clotrimazole vs. topical tolnaftate in the
treatment

of

otomycosis.

A

randomized

controlled clinical trial

//Brazilian journal of

otorhinolaryngology. – 2020. – Т. 86. – С. 300-307.

11.

Mofatteh M. R. et al. Comparison of the recovery
rate of otomycosis using betadine and

clotrimazole topical treatment

//Brazilian journal

of otorhinolaryngology. – 2018. – Т. 84. – С. 404-
409.

12.

Zhang L. L. et al. Molecular identification and in
vitro antifungal susceptibility of aspergillus
isolates recovered from otomycosis patients in

Western China //Mycopathologia. – 2020. – Т. 185.
– №. 3. – С. 527-535.

13.

Sabz G. et al. Clinical and microbial epidemiology
of otomycosis in the city of Yasuj, southwest Iran,
revealing Aspergillus tubingensis as the dominant
causative agent //Journal of medical microbiology.
– 2019. – Т. 68. – №. 4. – С. 585-590.

14.

Lou Z. The evaluation of endoscopic cartilage
myringoplasty to repair perforations with
otomycosis //American journal of otolaryngology.
– 2020. – Т. 41. – №. 4. – С. 102493.

References

Abastabar M. et al. Candida auris otomycosis in Iran and review of recent literature //Mycoses. – 2019. – Т. 62. – №. 2. – С. 101-105.

Safari F. et al. A Chronic Autochthonous Fifth Clade Case of Candida auris Otomycosis in Iran//Mycopathologia. – 2021. – С. 1-7.

Ali K. et al. Identification of fungal pathogens in otomycosis and their drug sensitivity: our experience //International archives of otorhinolaryngology. – 2018. – Т. 22. – №. 04. – С. 400-403.

Kiakojori K. et al. Assessment of response to treatment in patients with otomycosis //Iranian Journal of Otorhinolaryngology. – 2018. – Т. 30. – №. 96. – С. 41.

Carney A. S. Otitis externa and otomycosis //ScottBrown’s Otorhinolaryngology Head and Neck Surgery. – CRC Press, 2018. – С. 953-958.

Dundar R., İynen İ. Single dose topical application of clotrimazole for the treatment of otomycosis: is

this enough? //Journal of audiology & otology. –2019. – Т. 23. – №. 1. – С. 15.

Li Y., He L. Diagnosis and treatment of otomycosis in southern China //Mycoses. – 2019. – Т. 62. – №. 11. – С. 1064-1068.

Koltsidopoulos P., Skoulakis C. Otomycosis with tympanic membrane perforation: a review of the literature //Ear, Nose & Throat Journal. – 2020. – Т. 99. – №. 8. – С. 518-521.

Aboutalebian S. et al. Molecular epidemiology of otomycosis in Isfahan revealed a large diversity in causative agents //Journal of medical microbiology. – 2019. – Т. 68. – №. 6. – С. 918-923.

Jimenez-Garcia L. et al. Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial☆ //Brazilian journal of otorhinolaryngology. – 2020. – Т. 86. – С. 300-307.

Mofatteh M. R. et al. Comparison of the recovery rate of otomycosis using betadine and clotrimazole topical treatment☆ //Brazilian journal of otorhinolaryngology. – 2018. – Т. 84. – С. 404-409.

Zhang L. L. et al. Molecular identification and in vitro antifungal susceptibility of aspergillus isolates recovered from otomycosis patients in Western China //Mycopathologia. – 2020. – Т. 185.– №. 3. – С. 527-535.

Sabz G. et al. Clinical and microbial epidemiology of otomycosis in the city of Yasuj, southwest Iran, revealing Aspergillus tubingensis as the dominant causative agent //Journal of medical microbiology. – 2019. – Т. 68. – №. 4. – С. 585-590.

Lou Z. The evaluation of endoscopic cartilage myringoplasty to repair perforations with otomycosis //American journal of otolaryngology.– 2020. – Т. 41. – №. 4. – С. 102493.

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