Back
Year : 2015 | Volume : 3 | Issue : 2 | Page : 100 - 103  


Original Articles
A study of fungal infections in ear, nose and throat

Professor and Head, Department of ENT diseases, Malla Reddy Medical College for Women, Hyderabad

Corresponding Author:

Dr. V. Venkateswarlu,

Email: vallamreddy.venkateswarlu@gmail.com

Abstract:

Background: There is increase in the incidence of fungal infections in ear, nose and throat in recent times with increased use of cytotoxic drugs, broad spectrum antibiotics and immune-suppressive agents and advent of HIV infection. Hence a study is needed to understand the nature of fungal infections in ENT for effective treatment.

Objective: To study fungal infections in ENT areas with particular reference to etiology and predisposing factors.

Materials and Methods: This is a prospective study conducted at a tertiary government general hospital for one year. All the new patients attending the ENT department were screened for fungal infections and diagnosis was confirmed by relevant investigations. The data was analyzed for determining etio-pathogenesis and predisposing factors.

Results: The overall percentage of fungal infections in the new patients was found to be 2.19%. Young adult males with immuno-suppression were more commonly affected by them. Otomycosis is the commonest fungal infection and excessive use of local antibiotic ear drops is the commonest predisposing factor for it.

Conclusion: Fungal infections occur commonly in young adult males and immuno-suppression is the commonest predisposing factor.

Key words: Immuno-suppression. Fungal infections, ear, nose, throat

INTRODUCTION:

In recent years there is increase in the number of reports of fungal infections affecting nose para nasal sinuses and throat. Otomycosis is a continuing problem. In the present day medicine the advent of cytotoxic drugs, broad spectrum antibiotics, long term treatment with steroids and immuno-suppressive agents and HIV infection markedly increased the number and severity of fungal infections. 1, 2 Diabetes mellitus is another common condition often associated with fungal infection. The fungi those are capable of causing disease seem to do so because of their peculiar metabolism and possession of enzymes systems that give them ability to survive and grow at elevated body temperature at reduced oxidation and reduction environment of the tissues and the ability to overcome the host defense mechanisms. 3 Aero-digestive system of the human body and external ear are constantly exposed to environment. So many pathogenic saprophytic fungi present in the soil and opportunistic fungi in the human body invade the tissues when there is fall in the resistance of the host. The common fungal infection affecting the ENT areas are Candidiasis, Aspergillosis, Rhinosporidiosis, Mucormycosis, Coccidioidomycosis, Paracoccidioidomycosis, Histoplasmosis and Blastomycosis. 3

The diagnosis of the fungal infections involves X-ray, CT scan of the affected areas and laboratory identification of fungi. Some mycotic infections necessitate biopsy and histopathological examination of the involved tissues. Serological tests and skin testing with specific antigen are used in some fungal infections. 4 Treatment includes chemotherapy with antifungal drugs, surgical debridement of affected tissues and dealing with underlying cause.

MATERIAL AND METHODS

This study was conducted in ENT department of SVRR government general hospital, Tirupathi for one year from 01.08.1996 to 31.07.1997. During this period the new patients who attended the outpatient department of ENT specialty were screened for fungal infections and the patients who were affected for the first time were taken up for the study.

After detailed history taking and thorough clinical examination, the patients were subjected to routine base line investigations of blood and urine. In appropriate cases special investigations like X-ray CT scan and Elisa test were done. For confirmation of the diagnosis the material was collected from the lesions and sent to departments of Microbiology and Pathology. The fungal material was sent to the laboratory in sterile bottles containing normal saline and biopsy material was fixed in 10% Formalin and sent histopathological examination. For direct microscopic examination, the material was places on a glass slide in a drop of 10% Potassium hydroxide and examined under light microscope. The specimens for fungal culture were inoculated into two Sabouraud’s agar slants and incubated at 37 C. The slants were examined after 3-4 days for growth of fungal culture. The biopsy material was stained with haemotoxylin and eosin and examined under light microscope. Special stains like Grocott-Gomori Metholnamine Silver stain and PAS were used in appropriate cases.

RESULTS:

During the period of one year a total of 14,198 patients have attended the ENT OPD. Of these 9,291 were new patients. Among them 3,454 were found to be suffering from infective diseases. Out of these 204 patients were clinically diagnosed as suffering from fungal infections. But only 172 patients were confirmed by laboratory investigations. So the percentage of fungal infections in new cases is 2.19%.

Table-1: Age wise distribution of patients.

Age Range

Frequency

Percentage

0-10

7

4.07%

11-20

24

13.95%

21.30

53

30.81%

31-40

35

20.35%

41-50

26

15.12%

51-60

14

8.14%

61-70

06

3.49%

71-80

05

2.91%

81-90

02

1.16%

Total

172

100%

Table-2: Sex Incidence

Sex

Frequency

Percentage

Male

121

70.35%

Female

51

29.65%

Total

172

100%

 

Table-3: Distribution of fungal infections in three areas.

Ear

Nose

Throat

151

12

09

 

Table-4: Distribution of fungal species in otomycosis.

Fungal Species

Frequency

Percentage

Aspergillus Niger

99

65.5%

  1. fumigatus

48

31.7%

  1. flavus

01

0.9%

Candida albicans

03

1.9%

Table-5: Relation between predisposing factors and fungal infections

Predisposing Factor

Candidiasis

Apergillosis

Mucormycosis

Rhinosporidiosis

Total

Endemic areas

-

-

-

8

8

HIV infection

1

-

-

-

1

Neoplasia

2

2

-

-

4

Diabetes mellitus

1

2

3

-

6

Radiotherapy

2

2

-

-

4

Trauma

-

15

-

-

15

Oil instillation

1

37

-

-

38

Local antibiotic ear drops

2

58

-

-

60

Debility

3

-

-

-

3

Total

12

116

3

8

139

 

Out of 172 cases confirmed as fungal infections predisposing factors could be elicited in 139 cases only.

Figure: 1

 

 

Figure 2: Candidiasis

Yeast forms of candida from the material from the lesions -Grams stain (100 x).

 

Figure: 3

Otomycosis: Aspergillus fumigatus showing spherical vesicles at the tip of conidiophores. Chains of conidia are also seen-lacto phenol cotton blue preparation (40 X).

 

Figure 4: Mucormycosis

Microphotograph of mucosa of maxillary antrum showing mucor among the epithelial cells – P.A.S. stain

 

 

 

Figure 5: Rhinosporidiosis:

Microphotograph showing polypoidal lesions with squamous metaplasia of surface epithelium sporangia with chitinous walls are seen.

 

 

 DISCUSSION:

 

Fungal infections received rather scant attention in the past due to their limited occurence and benign nature. With advent of cytotoxic drugs, various broad spectrum antibiotics, immuno-suppressive agents, long term treatment with steroids and H.I.V infection the incidence of fungal infections is increasing. 2 So more attention is being paid to understand their nature so that effective management techniques can be instituted.                                        

During the period of study of one year, the percentage of fungal infections was found to be2.19%. Among 172 patients whose diagnosis was confirmed by investigations, the age group 21-40 yrs has highest incidence of 51.15%. Males are more commonly affected than females. This finding is in agreement with other studies in this field. 2 This can be explained by the fact that young adult males are more active and move out of house in pursuit of livelihood and are exposed to fungal spores more often.

As per figure-1 the incidence of fungal infections is more from September to December which include rainy and winter seasons. So moisture plays an important role in the causation of fungal infections particularly Aspergillosis. In otomycosis unilateral involvement is more common. Right ear is more often affected than the left. HS Sathish et al came to the same conclusion in their study. 2 This can be explained by the fact that most of the patients are right handed and meddle their right ear more often with foreign bodies than the left.                                                                               

In otomycosis, the fungus belonging to Aspergillus species more often involved. Aspergillus Niger is the commonest species. The same observations were made by HS Satish et al 4. 5 Prolonged use of antibiotic ear drops was found to be frequent predisposing factor in otomycosis. Excessive use of antibiotic ear drops causes destruction of commensal bacteria in the ear leading to unchallenged growth of fungus.                                                                  

3 cases of Mucormycosis were found in the study, all of them occurred in patients with diabetes mellitus. Diabetes mellitus with keto acidosis impairs the migration and phagocytosis of fungal spores by leucocytes. 6 Candidiasis was found to occur in patients with immuno-suppression like neoplasia, HIV infection, post radiotherapy, debility and malnutrition. 7 Immuno-suppression implies reduced capacity to surveillance and removal of fungal spores from tissues by leucocytes.  

8 cases of Rhinosporidiosis were recorded in the study. All of them gave history of taking bath in sacred tanks in and around Tirupati and Tirumala. It is a known fact that Sri Lanka and Tamil Nadu are endemic for Rhinosporidiosis. 8 When pilgrims from these areas take bath in the sacred tanks contamination of water with fungal spores occur and spread to others.              

 

CONCLUSION:

Fungal infections are more common in young adult males. Otomycosis is the commonest fungal infection in E.N.T patients. It is more common in rainy and winter seasons when moisture content is high in the environment. Excessive use of antibiotic ear drops causes otomycosis. Mucormycosis often occurs in patients with diabetic ketoacidosis. Candidiasis most often occurs in patients with immuno-suppression. Rhinosporidiosis is significantly influenced by endemic factors.

REFERENCES:

  1. Maran A.G.D. Logan Turners Diseases of the Nose, Throat and Ear. 1988; 10th Edition. 91-2.
  2. HS Sathish, Viswanatha. B, Manjuladevi. M. A Clinical Study of Otomycosis. IOSR Journal of Dental and Medical Sciences. 2013 Mar-Aprl ; 5(2): 57-62.
  3. Chester W. Emmons, Chapman H. Binford and John P. Utz. Medical Mycology. 1988; 3rd Edition.   25-6.
  4. Sydney M. Finegold and Ellen Jo Baron. Baily and Scotts Diagnostic Microbiology. 1986; 7th Edition. 35-6.
  5. Paulose KO, Al Khalifa. S, Shenoy. P et al. Mycotic infections of the ear (otomycosis)- A prospective study. Journal of Laryngology and Otology. 1989; 103(1) : 30-5.
  6. Bhattacharya AK, Deshpande AR, Nayak SR et al. Rhinocerebral mucormycosis an unusual case presentation. Journal of Laryngology and Otology. 1992; 106(1): 48-9.
  7. William JD Jr. Oral Manifestations of Human Immuno-deficiency Virus infection. Otolaryngologic Clinics of North America. 1992; (25): 1211-26.
  8. Chandrasekharayya SH, SS Suligavi, Sachin Chougule et al . Nasal Rhinosporidiosis Revisited. Clinical Rhinology: An International journal. 2010 May-Aug; 3(2) : 73-75




img

Important links

adv apply rec

Open Access Journal

MRIMS Journal of Health Sciences is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher of the author. This is in accordance with the BOAI definition of open access.

Visitor Count


756765
© 2020 Chandramma Education society . All Rights Reserved.