Aural myiasis: Description, Causes and Risk Factors:Invasion of the external, middle, or inner ear by larvae of dipterous insects.Myiasis, the invasion of the live mammalian tissue by larvae of dipteran flies to feed on the host's organs, body fluids, or ingested food, may be specific, semispecific, or accidental. It is believed that the fly may even drop its eggs in flight on the skin, wounds, or natural opening of an immobile person. Myiasis-producing larvae attack three main parts of the body: cutaneous tissue, body cavities, and body organs.The extent of disease and the host immune response depend on the fly species involved, the host and on the rearing conditions. Blowflies and flesh flies cause myiasis of relatively short duration by both obligate and/or facultative parasites, which mature within 4-7 days, usually at the host's body orifices and in wounds.Myiasis in humans may be benign to asymptomatic or may result in mild-to-violent disturbance. Infestation of the nose and ears are extremely dangerous because of the possibility of penetration into the brain; the fatality rate is approximately 8% in such cases. Myiasis is not an uncommon parasitic infestation in the tropics and subtropics, and due to international travel, cases are also encountered outside the endemic regions in both Europe and North America.Most of the identified causative agents belong to Sarcophagidae family. Among the sarcophagidae spp., Wohlfahrtia magnifica is frequently seen as a causative agent of various types of myiasis in the Mediterranean Basin, Southern Russia, Turkey, Israel and the Middle and Far East.To reduce the incidence of these infestations, preventative measures should be applied. If the tympanic membrane is perforated in aural myiasis cases, concomitant suction and antibiotic therapy will be appropriate.Symptoms:The aural myiasis is not a common infestation. Although it is not common manifestation in the field of Otorhinolaryngology, the possibility of its occurrence always exists. The clinical spectrum is wide from maggots in the ear to otalgia, otorrhea, perforation of the drum, bleeding, itching, roaring sound, tinnitus, furuncle of the external ear and restlessness.Diagnosis:The diagnosis of aural myiasis is made by the finding of fly larvae in tissue. Identification to the genus or species level involves comparing certain morphological structures on the larvae, including the anterior and posterior spiracles, mouthparts and cephalopharyngeal skeleton, and cuticular spines. Travel history can also be helpful for genus or species-level identification.Treatment:The treatment of aural myiasis is simple in early manifestation stage, such as removal of maggots and cleaning lesion with 70% ethanol, 10% chloroform, oil drops, urea, dextrose, creatine, topical ivermectine, and iodine saline or normal saline. However, they have controversial results. Prophylactic antibiotics therapy may prevent secondary infections. If the tympanic membrane is perforated cleaning with normal saline and concomitant suction will be appropriate.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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