A Case of Middle Ear Granuloma Caused by a Fungus

Abstract

We report a case of granulomas within the middle ear accompanying small yellow lumps within the granulation tissue in the epitympanum found during an operation.

The patient, a 74-year-old woman, was referred to our hospital because of suspected middle ear cholesteatoma. When tympanoplasty was performed, the epitympanum was filled with granulation tissue containing many yellow nodules. On histopathological examination, the yellow nodules were found to be yeast-like fungal masses with granulomas around them. The granulomas were rich in histiocytes and multinucleated giant cells. The postoperative course was good; however, fluconazole was administered for 4 weeks according to the guidelines for the management of deep mycosis.

The most common fungal disease in the ear, nose and throat area is fungal infection of the external auditory canal, and the causative fungus is often Aspergillus or Candida. In this case, the small nodules present in the epitympanum were considered to be caused by Candida parapsilosis detected before the surgery, and it is possible that yellow pigment was produced by Candida parapsilosis.

Pulmonary aspergillosis, pulmonary cryptococcosis, and histoplasmosis are well-known to cause fungal granulomas; however, in this case, the granuloma was considered to be caused by Candida parapsilosis.

We cannot find reports in the literature of middle ear granuloma caused by a fungus, and we consider this to be a very rare case.