What can you tell me about the fungus called aspergillus? My 14-year-old just had a small mass removed from her right ear that was cultured and found to be this fungal infection. The ENT doctor removed the soft mass, but my question is whether she still needs to be treated with an antifungal medication to make sure the fungus is completely gone. He feels the reason she got this condition was because she was overtreated with antibiotics over the last year. Any information would be most appreciated.

P.M.

Aspergillus is the name of a group of fungi classified as molds that are found everywhere in the environment. We are all constantly exposed to aspergillus, and the way the fungi affect us is largely based on the health of our immune systems. In severely immunocompromised patients, such as those who have undergone bone-marrow transplantation, aspergillus can cause severe pneumonia, invasive disease of the sinuses and brain, and, rarely, lethal ear infections.

In other people, aspergillus may cause allergic symptoms. A type of asthma called allergic bronchopulmonary aspergillosis occurs in some people whose bronchial tubes (airways that lead to the lungs) become colonized with the fungi. An allergic reaction causes shortness of breath and a cough that produces thick brown sputum. A similar syndrome can occur when aspergillus colonizes the sinuses, but instead of asthma, the patient develops sinusitis and hay fever.

Another condition caused by aspergillus occurs when the fungi grow into a mass inside a body cavity. Although the organisms do not invade the surrounding tissue or trigger an allergic response, the mass itself may cause symptoms. For example, if this occurs in a nasal sinus, a "fungus ball" forms that may obstruct sinus drainage, causing discomfort and leading to bacterial infection. A ball of fungi can also grow in a cavity in the lung left by treated pulmonary tuberculosis.

"Otomycosis" is a general term that describes fungal infection of the external ear canal. Typically, the fungus is only on the lining of the ear canal and does not invade the tissue. This is not a very serious condition, causing mainly itching and a little pain. Treatment is with meticulous cleaning of the canal, keeping it dry, and usually applying a topical antifungal agent. As to permanent cure -- well, that is something different. Most everyone can be temporarily cured of this condition, but it often recurs, because whatever predisposed them to the infection in the first place is likely to happen again. Predisposing factors are dampness and improper hygiene of the external ear canal.

However, it sounds as if your daughter only had a "fungus ball," the kind of aspergillus infection in which a mass fills a cavity. If there was no actual infection of the ear-canal lining, usually no further treatment is needed, and the patient is cured after removal of the ball. I am sure that your daughter's physician can handle such an infection. You may, however, want to make sure that the doctor does not think that the aspergillus is invading the tissue.