Figure 2: A picture showing an adult fly being removed with a cotton tip.
On physical examination, vital signs were Blood pressure=100/60, pulse rate=82 beats per minute, respiratory rate=16, temperature=36.5 degree centigrade, and saturation 96% off oxygen. On HEENT examination, the conjunctiva was hyperemic and the sclera non-icteric. Otoscopic examination revealed adult flies embedded in the right ear. The tympanic membrane was not visualized. The left ear is normal except for certain waxes on the wall of the external auditory canal. The Rinne test for the right ear is negative because the patient feels the vibration of the tuning fork while it was put on the mastoid process. There were no pertinent positive findings in the remaining systems.
Laboratory investigations were done to assess for comorbidities and risk factors. On complete blood count, white blood cells=5000, neutrophil=55%, hemoglobin=15gm/dl, and platelet=210000. Random blood sugar was 120mg/dl, and HIV test=non-reactive.
After written informed consent was taken the ear was irrigated with normal saline. There were about four adult flies that came out of the ear while flushing with intravenous fluid (fig.3).