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To the Editor:—
I appreciate Dr. Littell's comments on the otomycosis problem. I stated the following in the original communication: "The external auditory canal is a unique cul-de-sac lined by squamous epithelium. This pocket provides an ideal substrate for the growth of various saprophytic fungi which are incapable of producing disease. The most common is Aspergillus niger, which can grow in such profusion that a pure culture is grossly visible in the ear canal. Such growth does not provoke an inflammatory response."The point of disagreement here is not involvement of the pinna, but whether or not the presence of Aspergillus in the canal can be regarded as infection. Pathogenic fungi which inhabit and invade tissue cause an inflammatory tissue reaction. A niger is a saprophyte which does not invade tissue, but grows as an opportunist in the "test tube" environment of the ear canal. The watery discharge which may
Kingery FAJ. The Myth of Otomycosis. JAMA. 1965;191(12):1033. doi:10.1001/jama.1965.03080120067029