Fungal otitis externa, an infection of the external auditory canal caused by molds and yeasts, accounts for approximately 10–20% of ear canal infections accompanying high recurrence. The purpose of the current study was to assess the pattern of etiological agents of otomycosis and resistance profile as well as the rate of tympanic membrane perforation. A total of 1040 patients with symptoms of fungal otitis externa, in a period of two years, were investigated. The mycological tests revealed the presence of different fungi in 237 ears (22.8%). Fungal otitis was more related to filamentous fungi of the species Aspergillus flavus (54.43%), A. tubingensis (10.97%), and A. niger (8.86%), followed by yeasts, Candida orthopsilosis (7.59%), C. albicans (6.75%), and C. parapsilosis (5.06%). Tympanic membrane perforation rate was found to be 6.75% and was more common with otomycosis caused by A. flavus, A. tubingensis and C. albicans. In antifungal susceptibility tests, all tested drugs showed generally good activity against most isolates of molds and yeasts, while tolnaftate, clotrimazole, nystatin, and terbinafine had lowest effects. We found that among Aspergillus isolates, one A. niger isolate was resistant to voriconazole, and one A. flavus isolate was resistant to amphotericin B. Furthermore, among Candida species, three isolates of C. orthopsilosis showed high MIC values to fluconazole, two C. albicans isolates were considered fluconazole resistant and one isolate of C. parapsilosis was resistant to caspofungin and 3 isolates were resistant to fluconazole. Regarding the existence of the cases with perforated tympanic membrane and emerging species causing fungal otitis in the current report, the importance of the early physical examination, precise molecular identification, and the antifungal susceptibility evaluation is highlighted.

真菌性外耳道炎是一种由霉菌和酵母菌引起的外耳道感染，约占耳道感染的 10-20%，伴有高复发率。本研究的目的是评估耳真菌病的病原体模式和耐药性以及鼓膜穿孔率。在两年内共调查了 1040 名有真菌性外耳炎症状的患者。真菌学测试显示 237 只耳朵（22.8%）中存在不同的真菌。真菌性中耳炎与黄曲霉(54.43%)、塔宾曲霉(10.97%) 和黑曲霉(8.86%) 的丝状真菌有关，其次是酵母菌、念珠菌(7.59%)、白色念珠菌(6.75%) 和近平滑念珠菌(5.06%)。鼓膜穿孔率为6.75%，多见于黄曲霉、塔宾曲霉和白色念珠菌引起的耳霉菌病。在抗真菌药敏试验中，所有受试药物对大多数霉菌和酵母菌均表现出良好的活性，而托萘酯、克霉唑、制霉菌素和特比萘芬的作用最低。我们发现在曲霉菌分离物中，一种黑曲霉分离物对伏立康唑具有抗性，一种黄曲霉分离物对两性霉素 B 具有抗性。此外，在念珠菌属物种中，三种分离物对伏立康唑具有抗药性。C. orthopsilosis对氟康唑显示出高 MIC 值，两个白色念珠菌分离株被认为对氟康唑具有耐药性，1 个近平滑念珠菌分离株对卡泊芬净耐药，3 个分离株对氟康唑耐药。对于本报告中存在鼓膜穿孔病例和新发真菌性耳炎病例，强调早期体检、精准分子鉴定、抗真菌药敏评估的重要性。