What Are Preauricular Pits?

A preauricular pit—also referred to as a preauricular sinus or fistula—is a tiny, abnormal hole in front of the ear. 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 Pit Symptoms

A preauricular pit or opening is the beginning of a sinus tract that weaves itself underneath the skin of the ear. 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.

While this sinus tract and pit are not supposed to be there (it's a congenital defect), 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.

Possible Complications

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.

Infected preauricular pits need to be treated by a healthcare provider with antibiotics and sometimes incision and drainage of the pus-filled collection.

Causes

Preauricular pits are caused by a developmental defect 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 malformation.

Other Genetic Syndromes

Some cases of preauricular pits are linked to certain genetic syndromes, including:

• Branchio-oto-renal (BOR) syndrome: Can also cause other malformations of the throat and ear and may be associated with hearing problems and kidney abnormalities
• Beckwith-Wiedemann syndrome: Associated with abdominal problems and cancer of the kidneys and liver; may feature a large tongue and asymmetrical earlobes
• Mandibulofacial dysostosis: Abnormalities of the head and face, including a very small head that doesn't grow with the body, developmental delays, speech and language problems, and intellectual disability; also called Treacher Collins syndrome

Because of these potential associations, your pediatrician will likely refer your baby to an ear specialist called an otolaryngologist (ear, nose, and throat healthcare provider, or ENT) to make sure the pit is not a marker of something more serious. 

Diagnosis

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 abnormalities.

To better examine the pit or other possible abnormalities, 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 abnormalities are found, your healthcare provider may order a hearing test called an audiogram. If branchio-oto-renal syndrome is suspected, they may recommend a kidney ultrasound.

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.

Treatment

Preauricular pits don't typically require repair or closure, although they won't close on their own. If infections are an ongoing problem, however, sometimes a preauricular pit and sinus tract need to be surgically removed. Additional treatments depend on whether the pits are associated with other conditions and how those conditions are treated.

People with BOR syndrome may:

• Use a hearing aid
• Have surgery to fix structural defects of the ear or other deformities
• Need kidney dialysis or a kidney transplant

Beckwith-Wiedemann syndrome treatment often involves:

• Blood sugar monitoring and treatments to maintain normal levels
• Surgery to repair deformities of the abdominal wall or tongue
• Speech or physical therapy
• Monitoring for and treating tumors

For mandibulofacial dysostosis, treatment may include:

• Antibiotics for frequent ear infections
• Cleft palate repair
• Orthodonture
• Surgery on the ears, eyelids, cheekbone, or jaw for functional and/or cosmetic purposes
• Treatment of any heart problems
• Surgery to connect portions of the esophagus to each other

Prognosis

In most cases, children with just a preauricular pit are perfectly healthy and can live a typical life.

Most people with BOR syndrome have an average life expectancy. Kidney problems are the biggest cause for concern, but with proper treatment, many of those who develop end-stage kidney disease can lead full, productive lives.

Beckwith-Wiedemann syndrome can increase the risk of mortality due to multiple complications, but many children born with this condition have a typical lifespan and can have healthy children.

With proper treatment, people with mandibulofacial dysostosis can develop normal intelligence and have an average life expectancy.

Frequently Asked Questions

How do you keep a preauricular pit clean?

Preauricular pits that have no added complications can be cleaned in the same way as the rest of your body—with regular soap and water. No special attention to cleaning is necessary.

How common is preauricular sinus?

Preauricular sinus is a fairly common occurrence. It is present in about 5 to 10 out of every 1000 births.

A Word From Verywell

No one likes to think of their baby as having a congenital malformation, but it's important to remember that ear defects are common. While it's best to have your child checked out by an ear specialist to be sure, the good news about preauricular pits is that in most instances, they pose no risk to your child.