What Are Preauricular Pits?

A preauricular pit is a tiny hole in front of the ear. Also called a preauricular sinus or fistula, it may appear more like a dimple or a piercing in an odd place. A preauricular pit occurs as a result of fusion problems during the sixth week of gestation when the ear is developing.

Preauricular pits are common. In the United States, between .1% and .9% of babies are born with a preauricular pit. The prevalence is slightly higher in other countries; for example, in Korea, the prevalence is thought to be around 1.91%.

This article discusses preauricular pits, how they form, and possible complications of having a preauricular pit.

What Does a Preauricular Pit Look Like?

A preauricular pit or opening is the beginning of a sinus tract that weaves itself underneath the skin of the ear. A sinus tract is a channel that connects the surface of the skin to a deeper part of the body.

Sometimes the tract is short and other times it can be long with multiple branches coming off and zigzagging throughout the ear tissue. It may appear only on one side or on both. The pit and tract are parts of a congenital disorder, which means they are not supposed to be present. The good news is that in most instances, the pit is benign (harmless), isn't associated with other medical issues, and is generally not something to worry about.

Why Do Some People Have It?

Preauricular pits are caused by a developmental change in the ear while the fetus is in the womb. Experts also believe there's a genetic component. However, the reason this happens still isn't fully understood.

If both ears are affected, it's more likely there's a family history of this congenital condition.

Risks With Preauricular Pits

While the pit itself isn't harmful, it's important to watch it for a couple of potential problems:

• Infection: Symptoms include fever, pain, redness, swelling, and pus; this can lead to abscesses and cellulitis.
• Cyst: A slow-growing painless lump next to the opening could indicate a cyst, which raises the risk of infection.

How Are Preauricular Pits Diagnosed?

Your otolaryngologist will first want to rule out the genetic syndromes sometimes associated with preauricular pits. To do this, they will examine your child's head, ear, and neck for other problems.

To better examine the pit or other possible problems, your healthcare provider may order imaging tests, like a computerized tomography (CT) scan or magnetic resonance imaging (MRI) with contrast. These imaging tests can also help the healthcare provider rule out complications related to a preauricular pit like a cyst or an infection.

If other ear problems are found, your healthcare provider may order other tests such as a hearing test called an audiogram.

Ultimately, if a genetic syndrome is suspected, you will be referred to other specialists who can help you manage any organ-specific problems for your child.

How Are Preauricular Pits Treated?

Preauricular pits that are not infected don't typically need to be repaired or closed, although they won't close on their own. Sometimes, however, they can become infected or develop a cyst. When this happens, there are a number of treatment options, including:

• Antibiotic therapy
• Fine-needle aspiration
• Incision and drainage

If a pit gets infected frequently, surgical removal is indicated. The pit and tract must be completely removed, or it will recur.

When to See a Healthcare Provider

A preauricular pit doesn't require treatment unless certain symptoms develop. These symptoms can indicate a developing infection or a cyst:

• Pain, swelling, or redness around the pit
• Pus that appears in and around the pit
• A lump near the pit that grows slowly and may be painless

Summary

A preauricular pit is a common condition that is present at birth. People with this condition have a tiny hole in the front of the ear. It usually does not cause any problems and only requires treatment if it becomes infected or a cyst develops. When this happens, treatment options range from antibiotics to incision and drainage.