Significance of fungal flora in chronic suppurative otitis media

Introduction: Chronic suppurative otitis media (CSOM) is defined as infection of the middle ear that lasts for >3 months and is accompanied by tympanic membrane perforation. The incidence is higher in developing countries, especially among the low socioeconomic strata of the society. Many authors have focused their attention on the bacterial flora of CSOM, but very little is known about the mycological aspects of these, the importance of which has been increasing in the recent years. Objective: The present study was aimed to speculate the etiological fungal flora responsible for the cases of CSOM among patients who attended the Ear, Nose, and Throat Department of our hospital a tertiary care center in Uttarakhand. Materials and Methods: The total of 107 patients (both males and females) who were clinically diagnosed with CSOM and were on any antibiotics (oral, topical or systemic) for >14 days and still persisted with symptoms were included in this study. Results: Among the 107 cases of CSOM studied, fungi were isolated in 83 (77.57%). Majority of the patients were in second and third decades of life (62.62%). Of the 83 fungal culture positive cases, the predominantly isolated fungi were Aspergillus species (47%), Candida species (41%), and Penicillium species (9.6%). Among the Aspergillus, the predominant species were Aspergillus flavus (17 isolates) and Aspergillus niger (12 isolates). Candida albicans (19 isolates) and Candida tropicalis (9 isolates) were the commonly isolated species of Candida. Conclusion: A definite search for fungal etiology is desirable in all cases of CSOM. Prolonged use of topical antibiotics or antibiotics-steroids ear drops may cause suppression of bacterial flora and the subsequent emergence of fungal flora. This probably increases the incidence of fungal superinfection. Otologists should suspect mycotic otitis media in patients with continuous otorrhea and who do not respond to the antibacterial treatment.