Domestically Acquired Aural Myiasis in a Tennessee Girl Dante Allen Pappano, MD, MPH,* Rebecca Trout Fryxell, PhD,† Ernest Bernard, PhD,† and Heather Radu, MD* Abstract: We present the rare case of a 12-year-old girl from Tennessee with domestically acquired aural myiasis. Key Words: external auditory canal, maggot, myiasis (Pediatr Emer Care 2018;00: 00–00) A ural myiasis, infestation of the external ear canal and/or the middle ear, is a rare condition. Myiasis in general is considered a tropical disease seen most often in “developing” countries. We de- scribe a case of a 12-year-old girl who was seen at East Tennessee Children's Hospital with domestically acquired aural myiasis. CASE A 12-year-old girl with a history of cerebral palsy and global developmental delay presented to the emergency department for evaluation of “bugs in her right ear. ” Five days previously, her ear ex- amination had been normal at a primary care office visit. A day after that visit, she had been taken outdoors to enjoy the good weather. She now presented with 2 days of fussiness and ear drainage. On examination, she was non–toxic appearing. Live insect larvae filled the right external auditory canal (EAC). Approximately 15 larvae were removed with a curette followed by saline lavage (Fig. 1). After larvae removal, the tympanic membrane was visu- alized to be free of erythema or perforation. The EAC was mildly. Mineral oil was placed in the EAC prior to discharge. On follow- up, she had no further ear complaints; her mother has subse- quently placed cotton in her ears when going outdoors. Recovered larvae were allowed to grow to a more easily identi- fiable stage (Fig. 2) and ultimately identified as Megaselia scalaris. DISCUSSION Myiasis describes the infestation of a live vertebrate host by dipterous (true fly) larvae (“maggots”). 1–3 Outside the select pop- ulation represented by Sardinian sheepherders, 4 it is considered a rare human condition. 2,5,6 Infestation has been reported in a wide distribution of body sites. Cutaneous and wound myiases are most common followed by infestation of body cavities that open to the surface (ophthalmic, oral, nasal, aural, urogenital). Rarely deep tissue spaces have been involved: internal urogenital, intestinal, cerebral, tracheopulmonary. 1 Of the so-called cavitary myiases, aural myiasis is relatively rare. From the *East Tennessee Children's Hospital and †Department of Entomology and Plant Pathology, University of Tennessee Institute of Agriculture, Knoxville, TN. Disclosure: The authors declare no conflict of interest. Reprints: Dante Allen Pappano, MD, MPH, East Tennessee Children's Hospital, 2018 Clinch Ave, Knoxville, TN 37916 (e‐mail: epappano@aol.com). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161 FIGURE 1. Larvae removed using ear curette. FIGURE 2. Close up view of larva. ILLUSTRATIVE CASE Pediatric Emergency Care • Volume 00, Number 00, Month 2018 www.pec-online.com 1 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.