Otomyiasis: Endoscopic Extraction and Use of Topical Ivermectin

By June 7, 2019

Monteiro, Eduardo1; Morato, Sarah2; Pedrosa, Maisa2
1 Hospital Felicio Rocho, Belo Horizonte, Brazil;
2 ENT Resident, Hospital Felicio Rocho, Belo Horizonte, Brazil.

Otomyiasis is a parasitic condition that tends to affect vulnerable subjects in tropical countries. It is a rare entity and common consequence of chronic ear disease or poor personal hygiene. A 35 years-old man, with mental illness, presented to the hospital with a 1-day history of left otorrhea. On clinical exame, the left external auditory canal was occluded by larvae and otorrhea.

The patient was submitted to endoscopic ear surgery to remove larvae. There was perforation on the pars-flacida. The tympanomeatal flap was elevated in order to search for more larvae and wash antrum. 150 mg of ivermectin was macerated within hemostatic sponge and positioned on the external auditory canal afterwards.
The patient was given ciprofloxacin eardrops and oral amoxicillin and clavulanic acid to treat secondary infection. After 30 days, tympanic membrane was healed abd without perforations.

Aural myiasis treatment consists on removing the maggots with ear forceps, local disinfection and antibiotic treatment for secondary infections. Is our case, in addition to the traditional treatment, we used topical ivermectin, endoscopic ear surgery and general anesthesia. The patient didn´t have intraoperative complications and after 30 days of clinical follow-up the tympanic membrane was healed.

We propose that the use of topical ivermectin is a simple and effective treatment for ear myiasis and the use of endoscopic ear surgery as treatment provides a better view and complete larvae removal in one procedure.