Morphological type IBranching ductal system with no or less than two dichotomous branchings
Morphological type IIBranching ductal system with more than two dichotomous branchings, but no terminal lobular units
Morphological type IIIBranching ductal system with number of branchings and well developed lobular system
Table 1Summary of functional changes
Functional type IAll ducts and ductules are lined by secretory type of epithelium
Functional type IIMixture of ducts lined by secretory and apocrine type epithelium
Functional type IIIAlmost all ducts lined by apocrine type of epithelium
Functional type IVMixture of ducts lined by apocrine type of epithelium and involuting ducts lined by multilayered epithelium

External otitis: Fungal

History:
This is a 60 year old gentleman who presents with itching in his ear and decreased hearing. He has problems with cerumen and frequently has his ear irrigated. After the last irrigation, one month ago, he noticed weeping and drainage from his ear. Now the plugging and severe pruritis are his chief complaints.

Examination:
The canal is completely filled with a whitish debris. This can be wet or sometimes dry and airy. It has the appearance of mold.

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History:
The above set of pictures are from a patient that had chronic ear drainage for many years. She has a candida infection with chronic itching.

Information: Fungus is frequently the cause of inflammatory external otitis.Fungal infection: An infection in which fungi grow in the canal causing superficial redness of the bony canal wall skin with musty smelling exudate and powdery appearing debris (fungal mycelia). Moisture and immunosuppresion increase the incidence of this otitis.
Commonly due to the Aspergillus species, a saprophytic fungus that forms a grayish (Aspergillus fumigatus) blotting paper membrane covered with black spores (Aspergillus niger). May also appear white (Candida albicans) or yellow (Aspergillus flavus). Upon suction removal the underlying tympanic membrane appears injected, edematous, and denuded of epithelium. Adequate suctioning of the ear canal is necessary for therapy and prevention. Topical antifungal drops, acidifying drops, or antifungal powders are frequently used. This condition becomes chronic if not completely treated.

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