To the Editor.
—Dr Bennett responds to the question "How common is it to find a fungus that causes otitis?"1 by providing information on extremely uncommon fungal infections of the middle ear and mastoid bone. The most common fungal otitis, fungal infection of the external auditory canal, is only briefly mentioned. His statement, "Rarely, seriously immunosuppressed patients develop invasive otitis externa caused byAspergillus," should not be misinterpreted by readers. Saprophytic fungal otitis of the external auditory canal is common, is not usually associated with immunodeficiency, and is readily treated.Otomycosis is particularly common in moist, warm environments (eg, tropical climates) and in patients who have poor hygiene. Pruritus is the most common presenting symptom. Fungi can be isolated in up to 40% of all cases of external otitis. Fungal mycelia are easily recognized on examination of the ear canal. Aspergillus niger is most commonly seen. However, absence of
Patow CA. Fungi as a Cause of Otitis. JAMA. 1995;273(1):25. doi:10.1001/jama.1995.03520250039026