Nasal Myiasis

By

Dr. T. Balasubramanian M.S. D.L.O.

Synonyms: Myiasis narium; larva in the nose; Peenash (Indian term)

This is a common problem affecting patients in India. The predisposting factors being:

1. Poorly nourished patient with poor hygiene

2. Patient's with atrophic rhinitis

3. Patient's with leprosy in the nose

4. Diabetics with purulent sinus infections

5. Midline granulomatous lesions involving the nose

6. Malignancy involving the nose.

7. Syphilitic disease involving the nose

Etiology: This condition is brought about by the development inside the nasal cavity of larvae hatched from the eggs already laid by certain flies. The commonest of them being Lucilia hominivora or Sacrophaga Georginia. These flies get attracted by the foul smelling stench eminating from the nasal cavity and lays their eggs inside the nose of the patient. In addition to the stench these patients have a relatively insensitive nose because the sensory nerves are already damaged.

Symptoms:

There is a tickling sensation and sensation of something moving inside the nasal cavity. It is almost always associated with sneezing, foul smelling sero sanguinous discharge. The patients may have secondary infection of the nasal mucosa causing intense head ache. Oedema of eye lids are also common. The pateint may go in for septicemia. Worms can be seen coming out of the nasal cavity. If the patient has septicemia then there may be associated fever with chills. The patient may even become toxic and delirious. The mucous membrane of the nasal cavity is destroyed, inaddition the cartilages and bone also undergo necrosis.

Pic of a patient with midline granuloma of nose from whom maggots were removed

Treatment:

The use of various germicides inside the nasal cavity must be condemned because of their effects on the nasal mucosa. Liquid paraffin may be used to stiffle the worm. Liquid paraffin blocks or chokes the lung of the maggots thereby killing them. The killed worms can easily be removed. Chlorofom can also be used to kill the migrating worm making their manual removal easy. With the advant of the nasal endoscope complete removal of the worms is a possibility.

Video clip showing maggots from nose being removed