Aural myiasis in an asymptomatic patient with Alzheimer's disease: A case report and review of the literature

Abstract

Aural myiasis is an uncommon form of human myiasis characterized by infestation of the external auditory canal by dipterous larvae. Although myiasis is predominantly reported in tropical and subtropical regions, otologic involvement remains rare and has been only exceptionally documented in Morocco, where the published data are scarce and largely limited to isolated case reports. We report the case of a 77-year-old Moroccan woman with a 17-year history of Alzheimer's disease who presented with an asymptomatic aural myiasis. The diagnosis was incidentally made after family members observed live larvae in the right external auditory canal. Otoscopic examination revealed multiple larvae with an intact tympanic membrane. All larvae were successfully removed under endoscopic guidance following topical lidocaine application, and the diagnosis of Wohlfahrtia magnifica infestation was confirmed by parasitological examination. The patient received adjunctive oral ivermectin and remained asymptomatic, with no recurrence at 9-month follow-up. Aural myiasis should be considered in elderly or cognitively impaired patients, even in the absence of otologic symptoms. Early recognition and prompt mechanical removal remain essential to prevent complications and ensure favorable outcomes.