Original Article

Investigation of Etiologic Agents and Clinical Presentations of Otomycosis at a Tertiary Referral Center in Tehran, Iran


Background: Otomycosis is a superficial infection of the ear caused by a spectrum of various fungal agents and its epidemiology depends on geographical region and climatic condition. The aim of this study was to investigate the causal agents and clinical manifestations of otomycosis at a tertiary referral center in Tehran, Iran.

Methods: From Apr 2016 to Jan 2017 a set of 412 subjects with suspicion of external otitis were included. Clinical examination and specimen collection were performed by an otorhinolaryngologist. Subsequently, direct examination and culture were performed on specimens and isolated molds were identified morphologically. Yeast isolates were identified using CHROMagar Candida medium and PCR-RFLP of ribosomal DNA whenever needed. Data were analyzed using SPSS.

Results: Otomycosis was confirmed in 117 cases (28.39%) including 64 (54.7%) males and 53 (45.3%) females. Patients were within the age range of 10-75 yr and the highest prevalence was found in the age group of 46-55 yr (30.77%). Pruritus (89.74%) and auditory manipulation and trauma (83.76%) were the predominant symptom and predisposing factor, respectively. Among 133 isolates from 117 patients, Aspergillus niger (n=50, 37.59%) was the most common etiologic agent and Candida glabrata (n=25, 18.8%) was the predominantly isolated yeast. Furthermore, 16 cases of mixed infection were identified and coinfection due to A. niger and C. glabrata (seven cases) was the predominant pattern.

Conclusion: Our results revealed the high prevalence of C. glabrata and mixed infections in otomycosis patients. Therefore, mycological examinations should be considered for proper treatment.


1. Kaieda S (2008). Fungal infection in the otorinolaryngologic area. Nihon Rinsho, 66 (12): 2290-3 [in Japanese].
2. Cheraghsahar S, Kazemi S, Birjandi M, et al. (2017). Otomycosis in Western Iran: Clinical and Mycological Aspects. Arch Clin Infect Dis, 12 (2): e57287.
3. García-Agudo L, Aznar-Marín P, Galán-Sánchez F, et al. (2011). Otomycosis due to filamentous fungi. Mycopathologia, 172 (4): 307-10.
4. Latha R, Sasikala R, Muruganandam N (2010). Chronic otomycosis due to Malassezia spp. J Glob Infect Dis, 2 (2): 189-90.
5. Dorko E, Jenča A, Orenčák M, et al. (2004). Otomycoses of candidal origin in eastern Slovakia. Folia Microbiol, 49 (5): 601-4.
6. Ozcan M, Ozcan MK, Karaarslan A, et al. (2003). Concomitant otomycosis and dermatomycoses: a clinical and microbiological study. Eur Arch Otorhinolaryngol, 260 (1): 24-7.
7. Vennewald I, Klemm E (2010). Otomycosis: diagnosis and treatment. Clin Dermatol, 28 (2): 202-11.
8. Gharaghani M, Seifi Z, Mahmoudabadi AZ (2015). Otomycosis in Iran: A Review. Mycopathologia, 179 (5-6): 415-24.
9. Martin TJ, Kerschner JE, Flanary VA (2005). Fungal causes of otitis externa and tympanostomy tube otorrhea. Int J Pediatr Otorhinolaryngol, 69 (11): 1503-8.
10. Fayemiwo S, Ogunleye V, Adeosun A, et al. (2010). Prevalence of otomycosis in Ibadan: a review of laboratory reports. Afr J Med Med Sci, 39: 219-22.
11. Nwabuisi C, Ologe F (2000). The fungal profile of otomycosis patients in Ilorin, Nigeria. Niger J Med, 10 (3): 124-6.
12. Pontes ZBVdS, Silva ADF, Lima EdO, et al. (2009). Otomycosis: a retrospective study. Braz J Otorhinolaryngol, 75 (3): 367-70.
13. Kaur R, Mittal N, Kakkar M, et al. (2000). Otomycosis: a clinicomycologic study. Ear Nose Throat J, 79 (8): 606-9.
14. Fasunla J, Ibekwe T, Onakoya P (2008). Otomycosis in western Nigeria. Mycoses, 51 (1): 67-70.
15. Ho T, Vrabec JT, Yoo D, et al. (2006). Otomycosis: clinical features and treatment implications. Otolaryngol Head Neck Surg, 135 (5): 787-91.
16. Barati B, Okhovvat S, Goljanian A, et al. (2011). Otomycosis in central Iran: a clinical and mycological study. Iran Red Crescent Med J, 13 (12): 873-6.
17. Munguia R, Daniel SJ. Ototopical antifungals and otomycosis: a review (2008). Int J Pediatr Otorhinolaryngol, 72 (4): 453-9.
18. Mirhendi H, Makimura K, Khoramizadeh M, et al. (2006). A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nihon Ishinkin Gakkai Zasshi. 47 (3): 225-9.
19. Adoubryn KD, N'Gattia VK, Kouadio-Yapo GC, et al. (2014). [Epidemiology of otomycoses at the University Hospital of Yopougon (Abidjan-Ivory Coast)]. J Mycol Med, 24 (2): e9-15.
20. Kazemi A, Majidinia M, Jaafari A, et al. (2015). Etiologic Agents of Otomycosis in the North-Western Area of Iran. Jundishapur J Microbiol, 8 (9): e21776.
21. Aneja K, Sharma C, Joshi R (2010). Fungal infection of the ear: a common problem in the north eastern part of Haryana. Int J Pediatr Otorhinolaryngol, 74 (6): 604-7.
22. Nemati S, Hassanzadeh R, Jahromi SK, et al. (2014). Otomycosis in the north of Iran: common pathogens and resistance to antifungal agents. Eur Arch Otorhinolaryngol. 2014; 271 (5): 953-7.
23. Saki N, Rafiei A, Nikakhlagh S, et al. (2013). Prevalence of otomycosis in Khouzestan Province, south-west Iran. J Laryngol Otol, 127 (01): 25-7.
24. Kurnatowski P, Filipiak A (2001). Otomycosis: prevalence, clinical symptoms, therapeutic procedure. Mycoses, 44 (11‐12): 472-9.
25. Abdelazeem M, Gamea A, Mubarak H, et al. (2015). Epidemiology, causative agents, and risk factors affecting humanotomycosis infections. Turk J Med Sci, 45 (4): 820-6.
26. Nowrozi H, Arabi FD, Mehraban HG, et al. (2014). Mycological and clinical study of otomycosis in Tehran, Iran. Bull Env Pharmacol Life Sci, 3 (2): 29-31.
27. Jia X, Liang Q, Chi F, et al. (2012). Otomycosis in Shanghai: aetiology, clinical features and therapy. Mycoses, 55 (5): 404-9.
28. Pradhan B, Tuladhar NR, Amatya RM (2003). Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Ann Otol Rhinol Laryngol, 112 (4): 384-7.
29. Kiakojuri K, Rajabnia R, Jalili B, et al. (2015). Otomycosis in Adolescent Patients Referred to the Therapeutic Centers in Babol City, Iran. Jundishapur J Microbiol, 8 (5): e17138.
IssueVol 48 No 2 (2019) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v48i2.832
Otitis externa Aspergillus niger Candida glabrata Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
KAMALI SARWESTANI H, DAIE GHAZVINI R, HASHEMI SJ, REZAIE S, GERAMI SHOAR M, MAHMOUDI S, ELAHI M, TAJDINI A. Investigation of Etiologic Agents and Clinical Presentations of Otomycosis at a Tertiary Referral Center in Tehran, Iran. Iran J Public Health. 2019;48(2):331-337.