Invasive otitis externa due to Aspergillus species: case report and review.

Aspergillus flavus, an unusual cause of malignant external otitis, was identified in pure culture of tissue from two patients in which histologic examinations demonstrated branching septate hyphae invading the temporal bone. Both patients presented with protracted external ear pain. Multiple attempts at treatment with topical agents (polymyxin B sulfate-neomycin sulfate-hydrocortisone), oral agents (cephalexin and ciprofloxacin), and parenteral agents (ceftazidime and tobramycin) were unsuccessful before definitive diagnosis was made. Treatment with amphotericin B, followed by a more protracted course of itraconazole, resulted in an apparent cure for these patients. Follow-up examination at 15 months after the discontinuation of therapy with itraconazole demonstrated no recurrence of infection. Previously reported cases have predominantly involved immunocompromised persons, and these cases are summarized.