Case of aural myiasis
A 64-year-old man, living in a rural community, reported to the emergency department after complaining of pain, itching, and bleeding in his left ear for five days. Physical examination revealed many mobile larvae occluding the left external auditory canal, indicating aural myiasis. The larvae were removed using an ear aspirator, forceps, and sterile water irrigation (Panel B and Video 2). Further examination of the left ear revealed tympanic membrane perforation. Aural myiasis is a fly larvae of the order Diptera infection of the middle or external ear. Chronic otitis media, diabetes mellitus, and poor hygiene are also risk factors. The larvae are removed, and the ear is irrigated to expel any residual organisms. To prevent further infection, the patient was treated with topical and systemic antibacterial drugs and referred to the otolaryngology department for probable tympanoplasty. The symptoms had subsided seven days later.
Myiasis is a common parasitic infection commonly affecting people with direct interaction with animals
Myiasis is a common parasitic infection in mammals. It is more common in humans in rural regions where people have more direct interaction with animals. The sickness begins when a female fly lays eggs, which generate clinical symptoms related to the body site implicated. It can affect the ears, nose and paranasal sinuses, nasopharynx, oral cavity, and skin of the head and neck region, according to otolaryngology. Chronic suppurative otitis media, low socioeconomic position, swimming in stagnant water, and diabetes mellitus are all risk factors for myiasis in humans. Neglected children, old age, mental impairment, and poor personal cleanliness are all potential risk factors.
Aural myiasis is a rare ear infestation. According to a recent review paper, only 45 cases of auditory myiasis have been recorded. Myiasis can be defined as either obligatory or facultative. The host, most typically the goat and sheep, is an essential part of the maggots’ life cycle in the former, but not in the latter. This infestation (Sarcophagidae family, Wohlfahrtia magnifica species) is an obligatory parasite. The female fly is attracted to both normal and pathological secretions of mammalian orifices.
Signs and symptoms
Patients typically present to the hospital with ear pain, hearing loss, purulent or bloody ear discharge, ear itching, and/or tinnitus. Other possible indications of intracranial involvement include vertigo, facial paralysis, and/or neurological signs. The symptoms begin when the larvae that have been implanted begin to feed on the surrounding tissues. The infestation is typically detected through a history and clinical examination, which reveals larvae in the ear. It is less likely that additional tests will be required to diagnose it because the larvae are usually found near the external auditory canal because they require air to breathe.
In most cases, the therapy for aural myiasis is straightforward, requiring only the removal of the larvae and irrigation of the ear with one or more of the following solutions: alcohol, chloroform, normal saline, oil, ivermectin, or iodine. Prophylactic broad-spectrum antibiotics are also commonly used to avoid subsequent infections.
The larvae should be carefully removed under a microscope and inspected for any residuals. The optimal irrigation solution is disputed because they all get the same result. The purpose of irrigation is usually to kill and remove any remaining larvae, particularly those that are not visible or accessible upon examination.
When there is doubt regarding the extent of the disease or the presence of residual disease, surgical exploration may be required. Mastoid probing is frequently conducted in these situations to determine the degree of the infestation and to remove any residue. There was no suspicion of residual disease in this case, and there were no indications that would warrant the stoppage of intracranial extension. A CT scan also revealed intact bone landmarks and normal intracranial space, with no evidence of residual illness. We recommend that if a patient is going to have surgical exploration, a CT scan be performed first.
Source: NEJM