Nasal Myiasis (Maggots in Nose)
Definition: Infestation of the nose, nasopharynx, and paranasal sinuses by maggots (larval forms of flies), causing extensive destruction.
Nasal myiasis : Life cycle of fly
Aetiology
- Causative Agent: Flies, particularly genus Chrysomyia.
- Predisposing Factors: Foul-smelling discharge attracts flies to lay eggs (approx. 200 at a time).
- Atrophic Rhinitis (Ozaena).
- Syphilis / Leprosy.
- Infected wounds.
- Incubation: Eggs hatch into larvae within 24 hours.
- Seasonality (India): August to October.
Clinical Features
1. Initial Stage (Days 1–3)
Patient is often unaware of maggots.
- Intense irritation inside nose.
- Sneezing, Lacrimation, Headache.
- Appearance: Puffy eyelids and lips.
- Discharge: Thin, blood-stained fluid oozing from nostrils (May present as epistaxis).
2. Later Stage (Day 3–4 onwards)
- Maggots Emergence: Larvae crawl out of the nose.
- Odor: Foul smell surrounds the patient.
- Destruction:
- Extensive destruction of nose, sinuses, and soft tissue of face.
- Fistula formation (Palate or around nose).
- Destruction of the eyeball.
⚠ Complication: Death may occur from Meningitis.
Treatment
1. Maggot Removal
- Manual Removal: Pick up visible maggots with forceps.
(Note: Maggots try to retreat into dark cavities when light falls on them). - Chemical Instillation:
Chloroform Water & Oil: Instilled into nose to kill the maggots.
- Nasal Douche: With warm saline to remove slough, crusts, and dead maggots.
2. General Measures
- Isolation: Patient must be kept under a Mosquito Net.
Reason: To avoid contact with flies which can perpetuate the cycle. - Hygiene: Instruction on nasal hygiene before discharge.
📚 Source: Dhingra ENT | Chapter 29
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