Clinical presentation
We present a 14 year old grade 7 female patient who visited our hospital with a complaint of right ear pain of two years duration. She had been complaining of intermittent type of ear ache over the past eight years for which she visited a number of health facilities. The pain worsened over the past two years which led her to get evaluated at our institution. In addition, she complains headache, itching, roaring sound in her ear, tinnitus, loss of sleep, difficulty attending her school lesson, and minimal hearing loss. She tried to get rid of the discomfort by inserting a cotton tip into her ear and applying the Valsalva maneuver (fig.1). She observed plenty of worms coming out of her ear after being triggered by the cotton tip and following which she felt relief. Recently, she saw adult flies coming out of her right ear and flew away(fig.2 ). Otherwise, she has no fever, body weakness and change in behavior. She is the 3rd child for her families and has four brothers and three sisters. She takes shower once a week. She has no comorbid illnesses like diabetes mellitus and neuropathy.