Single most likely diagnosis
- Myiasis: This condition is directly related to the infestation of living tissue by fly larvae (maggots). The presence of maggots over the ear pinna strongly suggests myiasis, particularly if there's an open wound or necrotic tissue that attracts flies.
Other Likely diagnoses
- Infected wound or abscess: The presence of maggots could indicate a secondary infection of a wound or abscess near the ear, where the larvae have infested necrotic tissue.
- Eczema or dermatitis with secondary infestation: In cases of severe eczema or dermatitis, especially if there's open skin, there's a possibility of myiasis.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy: Although rare, the presence of maggots could be a sign of advanced malignancy with tissue necrosis, attracting flies.
- Neurological conditions leading to neglect or immobility: Conditions such as stroke, spinal cord injuries, or advanced dementia could lead to neglect of personal hygiene and care, increasing the risk of myiasis.
Rare diagnoses
- Foreign body reaction: In some cases, a foreign body in the ear could attract maggots, although this would be less common.
- Autoimmune conditions with necrotic lesions: Certain autoimmune conditions could lead to necrotic lesions that might attract flies, though this is less likely than other causes.