(A221) Fungal Otitis Externa: Diagnostic and Treatment Patterns in Primary Care and Specialty Clinics

Introduction: Fungal otitis externa (FOE) accounts for 10–15% of otitis externa (OE) cases and frequently presents first in primary care settings. This study investigates diagnostic and treatment patterns in primary care and the subsequent management of these patients in head and neck surgery (HNS) clinics.

Methods: A retrospective chart review was conducted for 129 patients diagnosed with FOE at a single outpatient center between 2022 and 2023. Data collected included demographics (gender, age, race), comorbidities, primary care diagnoses and examinations, number of appointments and treatments before HNS referral, initial HNS clinic management (treatment and cultures), and total visits required for disease resolution.

Results: Primary care examinations suggestive of FOE demonstrated a specificity of 0.80; however, only 13.2% of these cases received a specific diagnosis of FOE. Among patients with culture-confirmed FOE at the HNS clinic, 28.1% (16/57, p< 0.001) presented with primary care findings consistent with FOE. Neither the number of appointments or treatments before HNS referral nor initial HNS clinic management (including culture collection) significantly influenced time to resolution.

Conclusions: Primary care providers can reasonably diagnose FOE based on examination findings, as indicated by acceptable specificity. However, specific diagnoses are infrequently assigned, and a substantial proportion of patients presenting to HNS clinics with culture-confirmed FOE do not have primary care findings consistent with FOE. These findings suggest that many FOE cases may be iatrogenic in origin.