Chronic suppurative otitis media (CSOM) Due to Aspergillus nidulans: A case series from a tertiary care centre in Western India

• Author Details:   
• Himani Bhardwaj Pandya
• Riddhi Lalji Baria
• Saurabh Chhotalal Norris
• Nidhi Mihirkumar Bhalodia
• Binda Prakashbhai Pipaliya

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Background: Chronic Suppurative Otitis Media (CSOM) is a major public health problem in India. It is a persistent disease with a great risk of irreversible complications like hearing loss, particularly in the developing world. While bacterial pathogens are often implicated, fungal infections, particularly by Aspergillus species, are increasingly recognized as causative agents. Aspergillus nidulans, though rarely reported in otomycosis, appears to be emerging as a potential pathogen. This case series highlights the clinical presentation, predisposing factors, and laboratory findings in five patients with Chronic Suppurative Otitis Media due to Aspergillus nidulans.

Case Series: Five patients presenting to the ENT outpatient department with chronic ear discharge were clinically evaluated, and samples of otorrhea were subjected to Gram’s staining and culture on routine bacteriological media and Sabouraud Dextrose Agar (SDA). Fungal isolates were identified based on macroscopic and microscopic morphology (KOH and LPCB Mount), including the presence of Hülle cells.

Results: All five patients, ranging from children to adults, presented with unilateral or bilateral ear symptoms, including pain, itching, and discharge, with hearing loss and pruritus. History of ear cleaning with foreign objects, use of cotton buds, and co-existing conditions like diabetes or Chronic suppurative otitis media (CSOM), were noted. Fungal culture on SDA revealed growth of Aspergillus nidulans with characteristic morphological features. In some cases, growth was delayed, and direct microscopy was inconclusive. Management with topical antifungals and aural toileting led to symptomatic improvement.

Conclusion: These case series emphasize the importance of considering fungal etiology, especially Aspergillus nidulans, in recalcitrant CSOM, which is a treatment-resistant middle ear infection characterized by persistent otorrhea through a perforated tympanic membrane despite adequate and appropriate therapeutic interventions. Culture-based confirmation is essential for accurate diagnosis and tailored antifungal management. Increased awareness of non-fumigatus Aspergillus species in otitis media is warranted.