Preauricular Pits: A brief note
Preauricular pits are also known as preauricular cysts, fissures, or sinuses. A pit is essentially a sinus tract traveling under the skin that doesn’t belong there; it’s marked by a tiny opening to the tract, right in front of the ear and above the ear canal. In atypical cases, the opening appears below the ear canal, closer to the lobe.
A pit’s tract running underneath the skin can be either short or long and convoluted, with extensive branching. It’s more common for only one ear to have a preauricular pit.
Preauricular pits are congenital, meaning children are born with this malformation when ear development goes awry early in gestation. However, the malformation is not associated with hearing impairments, and only rarely associated with a genetic syndrome involving other problems. A baby born with a preauricular pit will be examined for other abnormalities to rule out these syndromes.
The main problem with preauricular pits, if they appear in an otherwise healthy child, is that they can lead to benign cysts or infections, including small pus-filled masses known as abscesses. When a child gets repeat infections, a surgeon may recommend complete removal of the pit. Otherwise, if the pit poses no chronic problems, it may be left alone.
Preauricular pits are different from preauricular tags, which are fleshy knobs of skin in front of the ears without an attached sinus tract. Tags pose only a cosmetic problem and not a risk of infection like pits do.
On the other hand, preauricular pits are less serious than—and must be differentiated from – a branchial cleft cyst. A branchial cleft cyst, which may appear as a small opening, skin tag, or dimpling on the side of the neck can become infected and drain fluid. All such malformations of the outer ear, when taken together, occur in less than 1 percent of otherwise healthy babies. They are considered a common congenital defect, even if the occurrence rate sounds low. Boys and girls are equally affected by outer ear malformations. And although these malformations don’t necessarily run in the family, when both ears are affected, a family history is more likely.
The visible part of the ear is called the auricle. It forms during the sixth week of gestation. When auricular development encounters fusion problems, a preauricular pit forms.
Signs and symptoms
Children with a preauricular pit don’t always have the same set of symptoms. Some also have a syndrome associated with their pit. The most common symptoms of a pit by itself and in conjunction with a syndrome include:
- A visible tiny opening in front of one or both ears.
- An opening that appears as more of a dimpling.
- Swelling, pain, fever, redness or pus in and around the pit, signaling an infection, such as cellulitis or an abscess.
- A slow-growing painless lump right next to the opening, signaling a cyst. A cyst also raises the risk of infection.
- Asymmetric earlobes and an abnormally large tongue in addition to pits in front of the ears can be a sign of Beckwith-Wiedemann syndrome. This syndrome is associated with abdominal abnormalities and kidney and liver cancers.
- Holes or pits in the side of the neck, pits and/or tags in front of the ear, hearing loss, and kidney abnormalities can all be a sign of branchio-oto-renal syndrome.