Myiasis of the ear is an infestation of the ear by maggots (the larval stage of flies). In the literature, there are only few cases reported about aural myiasis. It is more common to occur in tropical regions, where humidity and warm weather provide a good environment for this infestation. In this paper, a 12-year-old boy is reported to have unilateral earache for 3-day duration. Examination of the painful ear showed a tympanic membrane perforation with larvae (maggots) in the middle ear. They were removed by using a forceps and gentle irrigation of ear to expel any remnant. Further management included assessment of hearing, computed tomography (CT) scan, and outpatient follow-up.
Myiasis is a common infestation among mammals. In humans, it is seen more in rural areas where people are in more direct contact with animals [
A 12-year-old boy, previously healthy, presented to the emergency department complaining of right earache for 3-day duration. This ear pain started suddenly and the patient has described it as being mild to moderate in severity. The patient is complaining also of minor decrease in hearing and itching in the ear canal. There was no history of purulent, bloody, or clear ear discharge, tinnitus, vertigo, or facial weakness. There was no history suggestive of intracranial involvement. Social history showed that the patient lives in dessert with his family, in a Bedouin culture.
General clinical examination, vital signs, and examination of nose, throat, left ear, head, and neck were all within normal. Inspection of the right ear externally was unremarkable; there is mild to moderate tenderness with pressure over the tragus or by gentle movement of the auricle. Examination by otoscope and microscope showed mild edema and erythema of the external auditory canal, a clean central perforation of the tympanic membrane of about 5 mm (Figure
Microscopic view of the right ear, showing a clean central perforation of the tympanic membrane after the removal of the larvae.
Three alive larvae removed from the patient ear.
The patient was admitted to the ward overnight for further management. He was started on mild analgesics and prophylactic antibiotic treatment to prevent possible secondary infections. On the second day of admission, reexamination showed improvement of the pain, edema, and erythema and no more larvae in the ear.
The patient underwent audiological assessment (tympanometry and pure tone audiogram), which showed flat tympanogram (type B) and mild conductive hearing loss in the involved ear. Also he underwent CT scan to rule out any intracranial involvement, and it showed normal middle ear and intracranial structures and intact roof for middle ear and mastoid.
After that the patient was discharged, and outpatient follow-up was arranged for him. After 3 weeks of the discharge, the perforation healed completely, and the repeated audiological assessments were within normal.
Aural myiasis is a rare infestation of the ears. According to a recent published review article, there are only 45 reported cases of aural myiasis [
Patients usually present to the hospital complaining of ear pain, hearing loss, purulent or bloody ear discharge, itching in the ear, and/or tinnitus [
The treatment for aural myiasis is usually simple in most of the cases, requiring nothing more than removal of the larvae and irrigation of the ear by one or more of the following solutions: alcohol, chloroform, normal saline, oil, ivermectin, or iodine [
The larvae should be removed under microscope with careful inspection for any residual. The best choice for irrigation solution is debatable as all of them achieve the same outcome. The goal of the irrigation is usually to kill and expel any residual larvae, mainly the ones not visible or accessible on examination.
Surgical exploration is sometimes needed in patients when there is suspicion about the extent of the disease or for residual disease. In these cases, usually mastoid exploration is performed and the extent of the infestation is identified and if any residual is found it will be removed [
Management of these patients should also include hearing assessment to document any change in the hearing level and for future comparison.
Intracranial extension, at least theoretically, is a possible dangerous complication of aural myiasis. A review of the 45 reported cases diagnosed to have aural myiasis did not show any intracranial involvement secondary to an infested ear [
In conclusion, aural myiasis is a rare infestation of the ear. It occurs usually in patients with risk factors like chronic suppurative otitis media, low socioeconomic status, neglected children, old age, mental retardation, and poor personal hygiene. The clinical presentation may range from mild earache to manifestation of intracranial extension like seizure. Treatment is usually simple, by removal of the larvae, ear irrigation, and antibiotics to prevent any possible secondary infection.
The author declares that there is no conflict of interests regarding the publication of this paper.