Discussion
Aural myiasis is an uncommon infestation of the ears. Myiasis is categorized as an obligatory or facultative infestation. In the former, the host, most frequently a goat or sheep, is an essential component of the maggots’ life cycle, but in the latter, it is not [10]. Fly species from the Calliphoridae, Sarcophagidae, Gastrophilidae, Cuteribridae, Musca, Famina, Chrysomyia, and C. vicifiia families cause myiasis. The commonest genera causing myiasis belongs to Sarcophagidae [11]. Myiasis is more common in tropical and subtropical regions, and most cases recorded in the United States and Europe are in tourists coming back from these regions. In moderate climates, the larvae of cosmopolitan dipteran flies accidentally parasitize human skin (Hypoderma bovis and Gasterophilus intestinalis), the nose, paranasal sinuses, pharynx, and ears (Calliphora species, Lucilia sericata, and Musca domestica), the alimentary tract and urogenital system (Fannia canicularis), and the eyes, orbits, and periorbital tissues. [12]. Medical entomologists, veterinarians, and doctors frequently find it helpful to further categorize myiasis into several categories according to the body area and tissue affected [13]. That means traumatic myiasis, oral myiasis, aural myiasis, ophthalmomyiasis, enteric myiasis, urogenital myiasis, and rectal myiasis. Previously, almost all literatures have documented aural myiasis due to the infestation of fly maggots. To our knowledge, no paper has been published on ear infestation by adult flies. In contrast to those reports, this particular case is worth reporting due to the rarest of all myiasis cases.
According to the research, hosts are typically 60 years old, with a male-to-female ratio of 5.5:1. The incidence of myiasis may be associated with the level of sanitation currently in place, the density of the current fly population, and the individual’s economic situation. Patients who are intellectually handicapped, elderly, diabetic, chronic purulent otitis media, homelessness, alcoholism, psychological disorders or unwell, peripheral vascular disease as well as drug users, are more vulnerable to attack. [14-16]. In our case, the patient is only 14 years old school girl and has no comorbid illnesses. However, reports of newborn myiasis cases have also been made [17]. Human myiasis can be mild and asymptomatic or severe and potentially fatal since larval infestations of the eye, nose, and ears can enter the brain [18]. The same is true for this patient. She tolerated right ear pain over the past eight years though she visited a number of health facilities.
Aural myiasis can cause a variety of distinct signs and symptoms, such as otalgia, offensive otorrhea, aural fullness, bleeding, itching, a roaring sound, tinnitus, vertigo, and furuncles of the external auditory canal when larvae are present in the ear. Meningitis and hearing loss can result from damage to the auditory meatus [11, 12, 19]. The larval attack may cause damage to the ear canal’s surrounding tissue, including the bones, and very rarely, death [7]. Either mechanical tissue disruption or the larvae’s synthesis of the enzyme collagenase can result in tissue damage. Because the feeding maggots from a single egg batch may entice many additional ovipositing flies of numerous species, resulting in the aggregation of thousands of eggs and larvae, small, early infestations frequently grow into massive infestations with life-threatening implications [20]. After the deposited larvae begin to feed on the surrounding tissues, the symptoms appear. Usually, the history and clinical examination, which will reveal the larvae in the ear, are used to identify the infestation. Due to the fact that the larvae are typically found close to the external auditory canal because they need air to breathe, further testing to diagnose it is unnecessary [21].
Most of the time, treating aural myiasis is as simple as removing the larvae and irrigating the ear with one or more of the following solutions: Alcohol, chloroform, normal saline, oil, ivermectin, or iodine [9, 22-26]. Additionally, broad-spectrum preventive antibiotics are typically used to stop subsequent infections. Under a microscope, the larvae should be removed, and any remnants should be thoroughly examined. Given that they all produce the same results, it is difficult to determine which irrigation solution is better. The irrigation’s usual purpose is to kill and remove any remaining larvae, especially those that are difficult to see or reach on examination [21]. Sometimes patients require surgical investigation to determine the extent of the disease or to check for residual disease. In these situations, mastoid exploration is typically carried out to determine the degree of the infestation and, if any residue is discovered, it will be eradicated [27, 28].