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Human aural myiasis
Human aural myiasis GIUSEPPE MAGLIULO, MD, MARIO GAGLIARDI, MD, and RAFFAELLO D’AMICO, MD, Rome, Italy
A 52-year-old mentally retarded woman came to our department for evaluation and treatment of left aural myiasis. Seven days earlier she had reported sensing an itch in her left external auditory canal. This symptom was associated with intermittent severe pain. Clinical examination revealed a bloodtinged aural discharge. Through otomicroscopy, numerous animate maggots were seen (Fig 1). They were carefully removed with microsurgical forceps under an operative microscope. This maneuver was facilitated by application of the suction tip to their bodies (Fig 2). After mechanical removal of the maggots, the patient’s symptoms were completely relieved. The skin of the affected ear canal looked normal, and no abnormality involving the tympanic membrane was detected. The larvae were identified as Sarcophaga hemorrhoidalis. Several weeks later the patient was disease free. Aural myiasis is rare1-3 and occurs most often in children younger than 10 years because of their low level of personal hygiene. Infestation can also occur in adults, especially those who are mentally retarded, as was observed in our patient. Aural myiasis develops from fly maggots, the eggs of which are laid in meat, cheese, fish, or feces. Many families of flies (Calliphoridae, Sarcophagidae, Gastrofilidae, Cuterebridae, Musca, Famina, Chrysomyia, Calliphoridae vicius, Calliphoridae americanae) have been identified. Sood et al3 reported that the Sarcophagidae are the most commonly encountered. Most infestation occurs in developing countries; however, the prevalence has decreased over the years, and currently it is very rare. Diagnosis is easy through otomicroscopy, which reveals the presence of larvae. Initial presentation exhibits different clinical symptoms including ear pain, purulent or bloodtinged aural discharge, vertigo, and/or tinnitus. Usually the external ear canal shows granulation and/or debris associated in many instances with perforation of the tympanic membrane.2 It is interesting to mention that the maggots can inhabit a normal ear, as reported by Cosgrove4 and as observed in our case.
From ENT University “La Sapienza.” Reprint requests: Giuseppe Magliulo, MD, Via Gregorio VII 80, 00165, Rome, Italy. Otolaryngol Head Neck Surg 2000;122:777. Copyright © 2000 by the American Academy of Otolaryngology– Head and Neck Surgery Foundation, Inc. 0194-5998/2000/$12.00 + 0 23/11/100498 doi:10.1067/mhn.2000.100498
The treatment of choice is still debated and includes use of different materials: chloroform, oil drops, urea, dextrose, creatine, hypertonic saline, and iodine solution.2 Whatever substances are used, however, it is essential to mechanically remove the larvae. This must be followed by antibiotic therapy to avoid secondary infection. REFERENCES 1. Braverman I, Dano I, Saah D, et al. Aural myiasis caused by flesh fly larva, Sarcophaga hemorrhoidalis. J Otolaryngol 1994;233: 204-5. 2. Keller AP Jr, Keller AP. Myiasis of middle ear. Laryngoscope 1970;26:646-9. 3. Sood UP, Kakar PK, Wattal BL. Myiasis in otorhinolaryngology with entomological aspects. J Laryngol Otol 1976;90:393-9. 4. Cosgrove PC. Myiasis in the auditory meatus of newborn infant. BMJ 1946;March.
Fig 1. After suctioning of the aural discharge, maggots appear. Photograph is under focus because of the motility of the larvae.
Fig 2. Larvae removed.
777
A 52-year-old mentally retarded woman came to our department for evaluation and treatment of left aural myiasis. Seven days earlier she had reported sensing an itch in her left external auditory canal. This symptom was associated with intermittent severe pain. Clinical examination revealed a bloodtinged aural discharge. Through otomicroscopy, numerous animate maggots were seen (Fig 1). They were carefully removed with microsurgical forceps under an operative microscope. This maneuver was facilitated by application of the suction tip to their bodies (Fig 2). After mechanical removal of the maggots, the patient’s symptoms were completely relieved. The skin of the affected ear canal looked normal, and no abnormality involving the tympanic membrane was detected. The larvae were identified as Sarcophaga hemorrhoidalis. Several weeks later the patient was disease free. Aural myiasis is rare1-3 and occurs most often in children younger than 10 years because of their low level of personal hygiene. Infestation can also occur in adults, especially those who are mentally retarded, as was observed in our patient. Aural myiasis develops from fly maggots, the eggs of which are laid in meat, cheese, fish, or feces. Many families of flies (Calliphoridae, Sarcophagidae, Gastrofilidae, Cuterebridae, Musca, Famina, Chrysomyia, Calliphoridae vicius, Calliphoridae americanae) have been identified. Sood et al3 reported that the Sarcophagidae are the most commonly encountered. Most infestation occurs in developing countries; however, the prevalence has decreased over the years, and currently it is very rare. Diagnosis is easy through otomicroscopy, which reveals the presence of larvae. Initial presentation exhibits different clinical symptoms including ear pain, purulent or bloodtinged aural discharge, vertigo, and/or tinnitus. Usually the external ear canal shows granulation and/or debris associated in many instances with perforation of the tympanic membrane.2 It is interesting to mention that the maggots can inhabit a normal ear, as reported by Cosgrove4 and as observed in our case.
From ENT University “La Sapienza.” Reprint requests: Giuseppe Magliulo, MD, Via Gregorio VII 80, 00165, Rome, Italy. Otolaryngol Head Neck Surg 2000;122:777. Copyright © 2000 by the American Academy of Otolaryngology– Head and Neck Surgery Foundation, Inc. 0194-5998/2000/$12.00 + 0 23/11/100498 doi:10.1067/mhn.2000.100498
The treatment of choice is still debated and includes use of different materials: chloroform, oil drops, urea, dextrose, creatine, hypertonic saline, and iodine solution.2 Whatever substances are used, however, it is essential to mechanically remove the larvae. This must be followed by antibiotic therapy to avoid secondary infection. REFERENCES 1. Braverman I, Dano I, Saah D, et al. Aural myiasis caused by flesh fly larva, Sarcophaga hemorrhoidalis. J Otolaryngol 1994;233: 204-5. 2. Keller AP Jr, Keller AP. Myiasis of middle ear. Laryngoscope 1970;26:646-9. 3. Sood UP, Kakar PK, Wattal BL. Myiasis in otorhinolaryngology with entomological aspects. J Laryngol Otol 1976;90:393-9. 4. Cosgrove PC. Myiasis in the auditory meatus of newborn infant. BMJ 1946;March.
Fig 1. After suctioning of the aural discharge, maggots appear. Photograph is under focus because of the motility of the larvae.
Fig 2. Larvae removed.
777