Fungal malignant otitis externa: Pitfalls, diagnosis, and treatment

Hypothesis: Oral voriconazole is a viable alternative modality treatment to traditionally used intravenous vancomycin in the treatment of malignant otitis externa (MOE). Background: The incidence of MOE is on the rise, more so in Saudi Arabia where diabetes mellitus is endemic. Although Pseudomonas aeruginosa is the most common offending organism, we are observing an increasing number of fungal MOE, in particular, Aspergillus species. The clinical findings in these patients can be quite different from those of the classic gram-negative bacteria. Methods: Chart review of patients with a diagnosis of MOE who underwent oral voriconazole treatment. Results: Three cases of Aspergillus MOE are reported in detail, pointing the pitfalls in clinical findings, diagnosis, and management of this entity. Conclusion: Oral voriconazole proved to be an excellent alternative modality treatment in this population of patients with MOE.