What is the treatment for aural myiasis?

Treatment of Aural Myiasis

The treatment of aural myiasis primarily involves mechanical removal of larvae through aural toilet, followed by cleansing with physiological saline, especially in cases with tympanic membrane perforation. 1, 2

Diagnosis and Initial Management

• Identification: Aural myiasis presents as fly larvae (maggots) infestation in the ear canal or middle ear, often causing earache, otorrhea, and sometimes tinnitus 3, 4
• Risk factors: More common in:
  • Patients with poor hygiene
  • Mentally disabled individuals
  • Patients with chronic suppurative otitis media
  • Tropical regions with warm, humid weather 2, 1

Treatment Algorithm

Step 1: Mechanical Removal

• Primary intervention: Manual removal of larvae using forceps under direct visualization 1, 3
• For difficult visualization: Consider microscopic guidance similar to that used for aural toilet in otitis externa 5
• For edematous canals: Consider placing an expandable wick (preferably made of compressed cellulose) to facilitate access and medication delivery 5

Step 2: Irrigation and Cleansing

• For intact tympanic membrane: Gentle lavage with body-temperature saline solution or hydrogen peroxide 5
• For perforated tympanic membrane: Use only physiological saline for irrigation to expel any remnant larvae 2, 3
• Avoid: Ethanol or chloroform in cases with tympanic membrane perforation 2

Step 3: Topical Treatment

• For secondary infection: Apply topical antimicrobial drops 5
  • Ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension is effective for associated otitis externa 6
• Administration technique:
  • Position patient with affected ear upward
  • Run drops along the side of the canal until filled
  • Use tragal pumping to aid in getting drops into the ear canal
  • Keep patient in position for 3-5 minutes 5, 6

Step 4: Systemic Treatment

• For secondary bacterial infection: Consider systemic antibiotics if signs of spreading infection are present
• For pain management: Use oral analgesics such as acetaminophen or NSAIDs 6

Special Considerations

• Tympanic membrane perforation: Assess for middle ear involvement and potential damage requiring surgical repair 4
• Imaging: Consider CT scan to assess extent of infestation, particularly with middle ear involvement 3
• Follow-up: Schedule hearing assessment and follow-up to monitor healing and potential complications 5, 3

Prevention Measures

• Patient education: Emphasize importance of ear hygiene, especially in at-risk populations 2
• Environmental control: Advise keeping the ear dry and protected in endemic areas 6
• For chronic otitis media patients: Regular follow-up and management of underlying condition to prevent recurrence 2

Prognosis

The majority of aural myiasis cases (88.9%) can be successfully treated with simple aural toilet and topical treatments alone without requiring extensive surgical intervention 1. However, in severe cases with middle ear involvement, tympanoplasty may be necessary to reconstruct damaged structures 4.

Potential Complications

• Tympanic membrane perforation
• Middle ear damage requiring surgical reconstruction
• Secondary bacterial infection
• Hearing loss

Early intervention with proper mechanical removal and cleansing is essential to prevent these complications and achieve complete resolution 1, 7.