What is the treatment for nasal myiasis?

Treatment of Nasal Myiasis

The most effective treatment for nasal myiasis involves a combination of endoscopic removal of larvae under direct visualization, irrigation with antiparasitic solutions, and systemic antibiotic therapy to prevent secondary infections. This approach ensures complete eradication of the infestation while minimizing tissue damage.

Initial Management

Mechanical Removal of Larvae

• Endoscopic removal: Nasal endoscopy is superior to manual extraction for removing maggots, especially from deep and inaccessible areas 1
• Allows for complete visualization of the nasal cavity and paranasal sinuses
• Enables removal of larvae under direct vision, reducing the number of required treatment sessions

Chemical Irrigation

• Antiparasitic irrigation options:
  • Ivermectin solution irrigation: Highly effective for facilitating self-expulsion of larvae 2
  • Chloroform and turpentine mixture (1:4 ratio): Effective for killing larvae before manual removal 3
  • Saline irrigation: Helps flush out larvae and debris 4

Systemic Therapy

• Antiparasitic medications:
  • Oral ivermectin: Recommended as adjunctive therapy to irrigation and mechanical removal 2
  • Pyrantel pamoate: Single dose has shown effectiveness when combined with irrigation and debridement 4
• Antibiotics: Broad-spectrum antibiotics are indicated to prevent or treat secondary bacterial infections 5
• Anti-inflammatory agents: Consider dexamethasone or other corticosteroids if significant inflammation or angioedema is present 5

Treatment Algorithm

1. Initial assessment:

   • Evaluate extent of infestation
   • Check for complications (secondary infections, tissue necrosis)
   • Assess for predisposing factors (atrophic rhinitis is most common 3)

2. First-line treatment:

   • Nasal irrigation with ivermectin solution or chloroform-turpentine mixture
   • Endoscopic removal of visible larvae
   • Oral antiparasitic medication (ivermectin or pyrantel pamoate)

3. Follow-up care:

   • Daily saline irrigation
   • Repeat endoscopic examination and debridement until complete clearance
   • Continue antibiotics if secondary infection is present

Special Considerations

Severe Cases

• For extensive infestations with tissue necrosis, more aggressive debridement may be required
• Consider CT imaging to evaluate extent of involvement, particularly if sinuses are affected 2, 5

Prevention of Recurrence

• Address predisposing factors (especially atrophic rhinitis)
• Consider partial closure of nostrils in cases of atrophic rhinitis to improve the condition of nasal mucosa 3
• Educate patients on hygiene practices to prevent reinfestation

Monitoring and Follow-up

• Regular endoscopic examination until complete resolution
• Monitor for complications such as septal perforation, which may not require intervention if asymptomatic 5
• Follow-up to ensure no recurrence of infestation

Pitfalls to Avoid

• Incomplete removal of larvae can lead to continued tissue destruction
• Failure to address underlying conditions (such as atrophic rhinitis) may result in recurrence
• Delayed treatment can lead to extensive erosion of nasal structures and potentially intracranial complications 3

The conservative approach combining endoscopic removal, irrigation, and systemic therapy has proven both safe and effective, with resolution typically achieved within 2-3 days of initiating treatment 4.