Institute of Laboratory Medicine, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany.
Clin Dermatol. 2010 Mar 4;28(2):202-11. doi: 10.1016/j.clindermatol.2009.12.003.
Aspergillus and Candida spp are the most frequently isolated fungi in patients with otomycosis. The diagnosis of otitis externa relies on the patient's history, otoscopic examination under microscopic control, and imaging studies. Direct preparation of the specimens, particularly with optical brighteners, mycologic culture, and histologic examination, is very important and strongly recommended for the correct diagnosis. Patients with noninvasive fungal otitis externa should be treated with intense débridement and cleansing, and topical antifungals. Topical antifungals, such as clotrimazole, miconazole, bifonazole, ciclopiroxolamine, and tolnaftate, are potentially safe choices for the treatment of otomycosis, especially in patients with a perforated eardrum. The oral triazole drugs, itraconazole, voriconazole, and posaconazole are effective against Candida and Aspergillus, with good penetration of bone and the central nervous system. These drugs are essential in the treatment of patients with malignant fungal otitis externa complicated by mastoiditis and meningitis.
曲霉菌和假丝酵母菌是外耳炎患者最常分离出的真菌。外耳炎的诊断依赖于患者病史、显微镜控制下的耳镜检查和影像学研究。直接制备标本，特别是使用光学增亮剂、真菌培养和组织学检查，对于正确诊断非常重要，强烈推荐。非侵袭性真菌性外耳炎患者应进行强烈的清创和清洁，并局部使用抗真菌药物。局部抗真菌药物，如克霉唑、咪康唑、酮康唑、环吡酮胺和托萘酯，是治疗外耳炎的潜在安全选择，尤其是对于鼓膜穿孔的患者。口服三唑类药物，如伊曲康唑、伏立康唑和泊沙康唑，对假丝酵母菌和曲霉菌有效，对骨骼和中枢神经系统有良好的穿透力。这些药物在外耳炎伴乳突炎和脑膜炎的恶性真菌感染患者的治疗中至关重要。
