Preauricular Pits and the Hole in Your Child's Ear

A preauricular pit—also referred to as a preauricular sinus or fistula—is a small hole present in front of the ear that occurs as a result of fusion problems during the sixth week of gestation, when the ear is developing.

The 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.

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, appearing in isolation, and not something to worry about. That being said, it may rarely be associated with certain genetic syndromes like:

• Branchio-oto-renal (BOR) syndrome
• Beckwith-Wiedemann syndrome
• Mandibulofacial Dysostosis

This is why if you (or your pediatrician) notices a preauricular pit, your baby will be referred to an ear specialist called an otolaryngologist (ear, nose, and throat doctor, or ENT) to make sure the pit is not a marker of something more serious. 

Your otolaryngologist will first want to rule out genetic syndromes sometimes associated with preauricular pits. To do this, he will take a close look at your child's head, ear, and neck, as some syndromes cause other external ear malformations like asymmetric ears, pits in the neck, or inner ear problems that lead to hearing loss.

In addition, your doctor will see if the preauricular pit is present in one or both ears.

Sometimes to better examine the pit or other ear abnormalities, your doctor may order imaging tests, like a CT scan or an MRI with contrast. These imaging tests can also help the doctor rule out complications related to a preauricular pit like a cyst or an infection.

Other tests your doctor may order include a hearing test called an audiogram, although this is generally ordered only if other ear abnormalities are found in addition to the preauricular pit. In some cases, a kidney ultrasound is recommended, as the constellation of external ear malformations, hearing loss, and kidney impairment can be seen in the branchio-oto-renal syndromes.

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

A preauricular sinus is lined with skin cells and can get blocked and infected at any time. Infection can lead to abscess formation and cellulitis. 

The signs of an infected preauricular pit are redness, pain, fever, swelling, and/or yellowish, thick discharge. Infected preauricular pits need to be treated by a physician with antibiotics and sometimes incision and drainage of the pus-filled collection.

A pit can also accumulate material and become a cyst—a painless lump near the pit.

Preauricular pits do not typically require removal or closure, although they will not close on their own. However, sometimes a preauricular pit and sinus tract need to be removed surgically if infections are persistent or occurring repeatedly.

While no one likes to think of their baby having a congenital malformation, it's important to know that ear defects are common. The good news with preauricular pits is that in most instances, they are benign, posing no risk to your precious child.

However, it's best to have your child checked out by an ear specialist to be sure. If your child is healthy and not having any problems associated with the preauricular pit, you can leave it alone and get back to enjoying your child's giggles and unique personality.