Zhang Jilei, Lu Youqi, Liu Qi, Jing Yuanyuan, Yu Lisheng
Department of Otolaryngology Head and Neck Surgery，Peking University Peoples Hospital，Beijing，100044，China.
Beijing Huimin Hospital.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Jan;39(1):57-60. doi: 10.13201/j.issn.2096-7993.2025.01.012.
The objective of this study is to analyze the detection rate, the pathogenic fungus distribution, risk factors and drug sensitivity of fungal infection of external auditory canal in patients diagnosed with chronic otitis media. The data of a total of 419 patients with chronic suppurative otitis media or middle ear cholesteatoma who were admitted from January 2019 to February 2023 were retrospectively analyzed. A total of 419 patients were included, and 71 patients（16.9%） were positive for fungal culture. The disease mostly occurred in subjects aged 51-60 years old, and patients over 60 years old（47 cases, 66.2%）. From the fungal culture of external auditory canal secretions, 48 cases（11.4%） of Aspergillus and 14 cases（3.3%） of Candida were identified. The prevalence of fungal cultures in patients with chronic suppurative otitis media（20.8%） was significantly higher than that in patients with middle ear cholectestoma（4.9%）. The detection rate of Fungal was significantly increased after topical treatment with antibiotic ear drops（47.0% vs 13.6%）. Most of the isolated fungal strains are wild-type, and they are the sensitivity to voriconazole and fluconazole was the highest（97.2%）. For patients with positive fungal culture, iodoform gauze with triamcinolone acetonide and econazole cream was used to fill the external auditory canal during surgery. There was no significant difference in the tympanic membrane healing rate between patients with positive fungal culture and patients with negative fungal culture at 3 weeks after surgery（98.6% vs 97.7%）. Fungal infections of external auditory canal in patients with chronic otitis media tend to occur in older patients, which is more common in patients with chronic suppurative otitis media. Long-term topical treatment with antibiotic ear drops is an independent risk factor for fungal infection of external auditory canal in patients with chronic otitis media. The isolated fungal strains were highly sensitive to antifungal drugs. Therefore, it is advisable to refrain from employing topical antibiotic treatment for elderly patients with chronic suppurative otitis media/middle ear cholesteatoma, abuse of local antibiotic therapy should be avoided, and Fungal-related pathogenic examinations should be actively performed and anti-fungal drugs should be added if necessary.
本研究旨在分析慢性中耳炎患者外耳道真菌感染的检出率、致病真菌分布、危险因素及药敏情况。回顾性分析2019年1月至2023年2月收治的419例慢性化脓性中耳炎或中耳胆脂瘤患者的数据。共纳入419例患者，71例（16.9%）真菌培养阳性。该疾病多发生于51 - 60岁的人群，60岁以上患者居多（47例，66.2%）。从外耳道分泌物真菌培养中，鉴定出48例（11.4%）曲霉和14例（3.3%）念珠菌。慢性化脓性中耳炎患者真菌培养的患病率（20.8%）显著高于中耳胆脂瘤患者（4.9%）。局部使用抗生素滴耳液治疗后真菌检出率显著升高（47.0%对13.6%）。分离出的真菌菌株大多为野生型，对伏立康唑和氟康唑的敏感性最高（97.2%）。对于真菌培养阳性的患者，手术期间使用曲安奈德碘仿纱条和益康唑乳膏填充外耳道。术后3周真菌培养阳性患者与阴性患者的鼓膜愈合率无显著差异（98.6%对97.7%）。慢性中耳炎患者外耳道真菌感染倾向于发生在老年患者中，在慢性化脓性中耳炎患者中更常见。长期局部使用抗生素滴耳液是慢性中耳炎患者外耳道真菌感染的独立危险因素。分离出的真菌菌株对抗真菌药物高度敏感。因此，对于慢性化脓性中耳炎/中耳胆脂瘤老年患者，建议避免局部使用抗生素治疗，避免滥用局部抗生素治疗，应积极进行真菌相关病原学检查，必要时加用抗真菌药物。
