Man's Ear Infested With Flesh-Eating Maggots That Were Feasting on Eardrum

A man's ear was found to be infested with maggots after he went to a hospital in Portugal complaining of pain, itching and bleeding.

The 64-year-old was hospitalized after experiencing symptoms for five days. Doctors at Hospital Pedro Hispano in the city of Matosinhos described the rare case in a paper published November 24 in The New England Journal of Medicine.

They said a physical exam showed "numerous mobile larvae" were blocking the man's ear canal. The doctors used ear forceps to remove the larvae by irrigating the ear with water. They also found that a small area of the eardrum had been perforated by the larvae.

"The [characteristics] of the larvae, cylindrical, segmented, white yellow-colored body... were compatible with the Cochliomyia hominivorax species," Catarina Rato, one of the doctors treating the patient and a co-author of the paper, told Newsweek.

C. hominivorax, also known as the New World screwworm fly, is a parasitic fly that lays its eggs on other organisms, whose flesh its hatched larvae will eat. This infection is called myiasis.

Each female fly will lay up to 400 eggs in the flesh of animals, usually warm-blooded ones, after which the eggs hatch into larvae, according to a California Department of Food and Agriculture fact sheet about the species. The larvae burrow into the tissue, feeding on the flesh of their host and "screwing" deeper if the wound is disturbed, a unique behavior of the screwworm that can damage the tissue and lead to infections.

Such cases can be fatal if left untreated.

After feeding for five to seven days, the larvae drop to the ground, burrow into the soil and pupate for three to five more days before emerging as an adult. The fly is usually found in Central and South America, as well as a few Caribbean islands such as Jamaica and Cuba.

The patient in Portugal was treated with antibiotic ear drops, boric acid solution and oral antibiotics, Rato said.

The eardrops combine antibiotics and steroids to avoid bacterial infection and relieve inflammation and swelling, while the boric acid creates an acidic environment in the ear that is hostile to microbial growth.

Myiasis in humans is rare in the U.S. but relatively common in tropical and subtropical areas with poor socioeconomic regions. People from the U.S. tend to get infected when traveling, with those with untreated open wounds at the greatest risk, according to the U.S. Centers for Disease Control and Prevention.

Infestations can happen in any part of the body. In 2020, doctors described a case of a 7-day-old infant who had 55 larvae infecting its umbilical cord. In this case, the infant was treated with ivermectin at the site of the wound, as this paralyzes the parasite and kills the larvae.

The report said the areas most prone to infection by the parasite are the mouth, any open wounds, the scalp and natural orifices like the ears, nose and genitals. If the larvae are dead or decomposing in deep tissues, surgery may be required to remove them.

"Aural myiasis is a rare and unique clinical entity," Rato said regarding the man with the infected ear. "The most common risk factors are chronic otitis media [recurrent ear infection], diabetes, alcoholism, low socioeconomic status and swimming in stagnant waters."

The patient had no larvae present after a checkup seven days later.

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