Aural Myiasis- Rare case reported in NEJM

Dr Catarina Rato and Dr Gustavo Lopes at Hospital Pedro Hispano, Matosinhos, Portugal have reported a rare case of Aural Myiasis that has been published in the New England journal of Medicine.

Myiasis is rare infestation of live vertebrates with dipterous larvae more commonly encountered in patients with mental or physical disabilities It is a rare entity in the otolaryngology and there are only few cases reported in the literature, and most cases are seen in tropical and rural areas.In countries where it is not endemic, myiasis is an important condition, where it can represent the fourth most common travel-associated skin disease.

According to history, a 64-year-old man from a rural community presented to the emergency department with a 5-day history of pain, itching, and bleeding in the left ear.

On physical examination the attending physician s found numerous mobile larvae were found to be occluding the left external auditory canal (Panel A), a finding indicative of aural myiasis. An ear aspirator, forceps, and irrigation with sterile water were used to remove the larvae (Panel B ). Perforation of the tympanic membrane was identified on further examination of the left ear. Aural myiasis is an infestation of the middle or external ear by fly larvae of the order Diptera. Risk factors include chronic otitis media, diabetes mellitus, and impaired hygiene. Treatment involves removal of the larvae and irrigation of the ear to expel any remaining organisms. The patient was treated with topical and systemic antibacterial agents to prevent secondary infection and was referred to the otolaryngology department for possible tympanoplasty. Seven days later, the symptoms had resolved.

In cases of Aural Myiasis persistent ear itching, and pain, and irritability especially in patients with predisposing factors as mental retardation, dementia, and immunosuppression, oto myiasis should be kept in mind.

Reference:

Catarina Rato and Gustavo Lopes DOI: 10.1056/NEJMicm2005407