Combination ivermectin therapy to treat nasal myiasis: A case series

Objectives: Myiasis of the head and neck is characterized by infestation of fly larvae in the cavities of the ear, nose, mouth, or tracheotomy stoma. The most common site of infestation is the nasal cavity. While seen sporadically in developing countries with tropical climates, it is a rare condition to be found in developed countries. Treatment of this condition is variable and there is no true consensus on management of nasal myiasis because previous studies are limited to case reports. This study is the first case series in the Western literature to document the presentation and management of consecutive patients with nasal myasis.Methods: All cases of nasal myiasis were evaluated from a single institution over a one-year span. All patients were treated with nasal cavity debridement followed by treatment with systemic and topical irrigations of ivermectin for seven days.Results: Five patients were identified to have nasal myiasis during the study period. The average age was 46.4 years, and 60% were male. All patients were sedated or comatose and intubated prior to myiasis onset, and 60% had a nasogastric tube (NGT) in place at the time of ENT consultation. The average time from hospitalization to infection was 4.2 days. After completion of therapy, all patients were deemed clear of infection.Conclusion: This serves as the only known case series of nasal myiasis in western literature and provides a treatment regimen that has been both safe and effective in practice thus far.