Abstract

Relevance: Acute diffuse external otitis (ADO) is a common ears condition’ affecting up to 10% of the healthy population, particularly during summer months, due to increased sweating and water entering the ears.

Objective: to study the spectrum of pathogenic and conditionally pathogenic microorganisms responsible for acute diffuse external otitis, determine their frequency of occurrence and colonization density, and the possible associations of two or more pathogens (bacterial and/or fungal) in single patient. Additionally, to evaluate the therapeutic efficacy of the combined drug Candibiotic in the treatment of such cases.

Materials and methods: A total of 35 patients (47 affected ears) aged 13 to 78 years (mean age 47.5±12.2 years) with acute diffuse external otitis (ADO) were examined. The cohort included 10 (28.6%) women and 25 (71.4%) men. Clinical symptoms included ear congestion and discharge in all patients (100%), with 91.4% presenting discharge with an unpleasant odor. Other symptoms were hearing loss (91.4%), subjective tinnitus (80.0%), ear pain and discomfort (85.7%), itching (37.1%) and low-grade fever (14.3%). The study has provided a detailed description of the otological examination procedures, specimen collection, and microbiological methods used to identify the full spectrum of bacteria associated with ADO.

Results: All patients received monotherapy with Candibiotic. The study has showed that within 1 month of the starting treatment clinical signs of ADO resolved in 94.3% of patients, and the complete recovery was confirmed microbiologically. In only one patient, Aspergillus flavus was still detected after 1 month, but at a significantly lower concentration than the previously. By the fifth week, no fungal growth was observed in the culture. These results demonstrate the efficacy of the studied drug against bacterial and fungal pathogens of ADO.

Conclusions

1. Successful treatment of patients with acute diffuse external otitis (ADO) requires a thorough assessment of the entire skin of the external auditory canal (EAC), especially its anterior-internal parts near the tympanic membrane. These areas should be carefully cleaned of pathological secretions, followed a microbiological examination of the sample. Topical medicines should be applied to the entire wall of the EAC, from the entrance to the tympanic membrane, according to the bacteriogram.
2. The most frequent bacterial pathogens of ADO were S. aureus (18.8%), followed by S. epidermidis (17.1%), and P. aeruginosa (14.3%). The most common fungal pathogen was A. flavus (25.7%). Mixed fungal-bacterial infections were detected in 43.5% of patients, highlighting the need for combined local therapy.
3. The use of Candibiotic as monotherapy in the treatment of ADO has proved to be effective both in terms of rapid reduction of clinical symptoms and in terms of clearance of bacterial and fungal pathogens from the external auditory canal.

Keywords: diffuse external otitis, clinical picture, microbiological examination, Candibiotic.