What is the treatment for nasal myiasis?

Treatment of Nasal Myiasis

The most effective treatment for nasal myiasis involves nasal irrigation with ivermectin solution followed by endoscopic removal of larvae, combined with systemic antibiotics to prevent secondary infections. 1

Initial Management

Step 1: Nasal Irrigation and Chemical Agents

• Apply nasal packing with a mixture of chloroform and turpentine (1:4 ratio) to kill the larvae 2
• Alternatively, use ivermectin solution for nasal irrigation, which has shown effectiveness in causing larvae to self-expel within minutes 1
• Saline irrigation is also effective for flushing out dead larvae and debris 3

Step 2: Mechanical Removal

• Endoscopic removal is superior to manual extraction 4
  • Allows visualization of larvae in deep and inaccessible areas
  • Results in more complete eradication
  • Requires fewer treatment sessions
  • Prevents irreparable damage to intranasal tissues
• Manual extraction with toothed forceps may be used for superficial larvae but is less effective than endoscopic approaches 1

Step 3: Systemic Therapy

• Oral ivermectin should be administered to kill remaining larvae and prevent recurrence 1
• Broad-spectrum antibiotics are recommended to prevent secondary bacterial infections 5
• Consider dexamethasone for cases with significant inflammation or angioedema 5

Special Considerations

Evaluation for Predisposing Factors

• Atrophic rhinitis is the most common predisposing factor for nasal myiasis 2
• Investigate for underlying conditions such as mucocutaneous leishmaniasis that may predispose to infestation 1
• CT scan should be performed after treatment to ensure complete clearance of larvae from sinuses 1

Prevention of Recurrence

• Partial closure of nostrils may be considered in cases of atrophic rhinitis to improve the condition of nasal mucosa 2
• Maintain good hygiene practices to prevent reinfestation 5
• Schedule follow-up examinations to ensure complete resolution and identify any complications such as septal perforation 5

Potential Complications

• Extensive erosion of the nose, face, and intracranial structures if left untreated 2
• Meningitis and death in severe cases 2
• Septal perforation may occur but is often asymptomatic and may not require surgical intervention 5

Treatment Algorithm

1. Initial assessment and diagnosis through clinical examination
2. Nasal irrigation with ivermectin solution or chloroform-turpentine mixture
3. Endoscopic removal of larvae under direct visualization
4. Administration of systemic therapy (oral ivermectin and antibiotics)
5. Post-treatment imaging to confirm clearance
6. Follow-up to assess for recurrence or complications

This approach has been shown to effectively resolve nasal myiasis within days, with patients recovering without sequelae 3.