Preauricular Pit or Sinus

Preauricular Sinus
Preauricular pits or sinuses are present in front of the ear. they are small skin lined tracks that lead from the skin surface to deep within the tissues in front of the ear.Their track course can go into the cartilage or end in the skin tissue.
Why does a preauricular sinus or pit occur?
A preauricular sinus or preauricular pit occurs as a result of faulty fusion in the development of the ear while the child is in the womb so it is a congenital condition present from birth.
What does a preauricular sinus signify?
The presence of a preauricular sinus may be associated with
  • Other abnormalities of the Outer ear: Helix abnormalities, Asymmetry, Posterior Angulation, Small size, Absent Tragus, and Narrow external auditory meatus.
  • Syndromes-Branchiootorenal syndrome, Mandibulofacial dysostosis, Beckwith-Wiedemann syndrome [Pediatricians and ENT Surgeons should always rule out syndromes in a child with preauricular pits]
Does a preauricular pit close by itself?
No a preauricular sinus or pit does not close by itself.
What complications can happen in a child or adult with a preauricular sinus?
A preauricular sinus is lined by epithelium and can get blocked and infected at any time.Many persons may not have infection.But if infected it can lead to abscess formation and cellulitis.A pit can also accumulate material and become a cyst which is a swelling with a propensity to get infected.Hence Doctors advise to remove a preauricular sinus.
What are the signs of an infected Preauricular sinus or pit?
Parents of a child with a preauricular sinus need to look out for infection of the sinus tract
  • The preauricular pit can discharge yellowish pus
  • The area around the preauricular pit can become red
  • The preauricular pit and surroundings can become swollen
  • The area in front of the ear can become tender to touch
  • Reddish or Brownish tissue growth[granulation tissue] at the mouth of the preauricular sinus
  • Fever can occur
The Cardinal Signs of Infected Preauricular Sinus are
  • Pain
  • Swelling
  • Redness
  • Pus Discharge
What is the treatment of a Preauricular Sinus or Pit?
  • Rule out other Congenital abnormalities [syndromes] in children
  • Surgical Excision is the management of Choice
  • Infected Preauricular Sinuses are treated with antibiotics before surgical removal
What type of Surgery is required to remove a Preauricular Sinus?
Preauricular Sinus Excision Under Local Anesthesia


In adults the surgical excision of a preauricular sinus can be performed under local anesthesia.The pictures shown below is that of a preauricular sinus surgical excision performed under local anesthesia [ by numbing the area].The duration of the procedure varies from 15 mins to 1 hour depending on the tract length and complexity.On an average it will take about 30 minutes.In young children it is done under general anesthesia.
Will rest be required after the procedure to remove the preauricular sinus?
No Generally ,no hospital stay is required and the person can resume normal activities.Care of the operated area involves keeping it dry and Dr Sonia or Dr Prateek Nayak will give you detailed instruction on the care of the area.

Preauricular Sinus Removal

Excised Preauricular Sinus Tract



















Dr Prateek Nayak
MBBS MS ENT[AIIMS]
Consultant ENT Surgeon Head & Neck Specialist,Bangalore
Dr Sonia & Dr Prateek's ENT Head Neck Center,Sahakaranagar, Bangalore
http://www.entbangalore.com
Mobile:9343848808

79 comments:

  1. Hi Doctor...my son age 20 old months has Preauricular ear sinus and we already bring him to ENT doctor and got antibiotic medicine. The doctor said that there is infected sinus and must treatment with antibiotic before get surgery. Question :
    1. is it safe for children with age 20 old Months to get this surgery?
    2. How do we know that the infection is curing and ready for surgery?
    Thx

    ReplyDelete
    Replies
    1. Dear Mr Adnan
      Thank You for writing to me.
      1.Yes it is safe for such young children to undergo surgery in competent hands
      2.Your ENT Surgeon will tell you when your child is fit for surgery based on the clinical response of the infection
      All the best
      Dr Sonia S V

      Delete
    2. Hi......i am 21yrs old male in my right side one Preauricular sinus is present is it risk for surgery?How much time required to fit after the surgery?

      Delete
    3. Hi......i am 21yrs old male in my right side one Preauricular sinus is present is it risk for surgery?How much time required to fit after the surgery?

      Delete
    4. Thank You for writing to me Mr Sandeep. Pre auricular sinuses need to be operated.one day off from work is advised

      Delete
    5. Dear Dr. Sonia , I have pits on both sides. The Right pit is bigger and drains often. The left one is small and rarely drains. Would you advise to have them surgically removed to prevent any infection. I am more concerned with the right one. There is a small bump horizontally to my pit.

      Delete
  2. how much does this surgery cost?

    ReplyDelete
    Replies
    1. It depends on where the surgery is opted, physical and anesthesia fitness

      Delete
  3. AnonymousJune 19, 2012

    how much does a surgery like this cost?

    ReplyDelete
  4. Hi doctor,

    Iam from bangalore , I too have a Preauricular Pit or Sinus in the same part as in pic, every time it gets swollen and puss will come out.Yearly once it comes it's been 9 times so far i have been breaking and removing pus.

    Pls advice me.

    ReplyDelete
    Replies
    1. It is advisable to get it operated even before infection occurs!

      Delete
  5. I have a question I have the hole on my ear yellow hard stuff was coming out of my ear everytime I pulled more out it just grew back is this okay

    ReplyDelete
    Replies
    1. Visit an ENT specialist in your locality as this needs to be evaluated

      Delete
    2. Good day Dr.! I just want to ask if taking amoxicillin and antiinflammatory drugs would help subside the swollen area?? really don't want to get a surgery. The last time I had a problem like this was 6 yrs ago. THANKS!

      Delete
    3. Having surgery is recommended to prevent infections and abscesses but it is not recommended when there is active infection

      Delete
  6. Hello Dr. Sonia I have a pit it is always itching and discharging pus. Does that mean it is infected?

    ReplyDelete
    Replies
    1. The pit has to be operated to prevent infection if you already do not have infection! Frank infection will make the area painful and tender to touch as well

      Delete
  7. Good Day Dr, Already answered of my question same, yet I want to know how much surgery cost for average work, this important because we are from outside of India .

    ReplyDelete
    Replies
    1. It is a fairly straight forward surgery and I would advise you to discuss it with your operating surgeon as it would vary from country to country and even within one country from city to city!

      Delete
  8. doc, i have pits in both ears. it itch when discharge pus, is it still infected though it doesn't pain and no redness? my siblings have one, but no discharge. are they acquired to have surgery? i have this discharge long years ago. i grew believing that this is normal. what would happen if i wont undergo operation soon? is it too late for me? as i start having discharge when i was 6? i am now 22 y/o. sometimes when draining it my head aches... is is true that this would cause another infection? i read a story of opted. said, it still discharge. some have operation for 3x but still have discharge...

    ReplyDelete
    Replies
    1. There is no "late" age as such for operation. Do consult your local ENT Surgeon and if he or she is willing get it operated. Not all ENT Surgeons will be ready to operate a preauricular sinus due to the intricate anatomy of the area.All the best

      Delete
  9. Hi Dr. Sonia,

    My 21 months old daughter has this tinny whole (pit) on the upper side of her right ear. Since couple of days, the pit is becoming red and swollen tho no pus is coming out.

    According to your answers above, is it safe for such surgery in such age. Is it really necessary or can we wait until she turns 10 years for example?!

    Thank you

    ReplyDelete
    Replies
    1. Redness and Swelling is a sign of inflammation/infection. The advice to get it operated early is to prevent repeated infections.I would not advise you to wait till 10 years!

      Delete
  10. hi im 17 my preauricular pit is sore & hurts when I push down on it. but, my family & I DO NOT want it surgically removed.. what can I do to get rid of the soreness, like a hot rag or something ?

    ReplyDelete
    Replies
    1. Hi Briana if its sore it means its inflamed. The minimum treatment which you require will be a course of anti inflammatory medicines
      Visit an ENT specialist in your locality

      Delete
  11. My eight month old son has two preauricular pits, one on each ear. I've been told that this is odd. Usually people only have one pit I guess. He also has a fistula of the tear duct but it's right next to his eye, which I was also told was odd, he actually has to have surgery to have the fistula fixed. But my baby has a double ear infection and both pits have been draining so now his pediatrician has sent him to yet another specialist, this time an ENT. I'm so stressed about all this, the baby is traumatized from doctors poking at his eye and ears and the idea of three surgeries before he's a year and a half old is maddening. Do you have any advice or am I doing everything right?

    ReplyDelete
    Replies
    1. It is not unusual to have preauricular sinuses on both sides. You are doing all the right things and you have been advised what is best for baby...be courageous
      All the best
      Dr Sonia S V

      Delete
  12. Hi I'm a first time mom & my daughter is two weeks old & she has them on both ears I just want to know is it necessary for her to have surgery

    ReplyDelete
    Replies
    1. Since your baby is just 2 weeks old there is no rush. When you go for your routine check up to your pediatrician ask for a referral to a reputed pediatric ENT Surgeon in your place

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  13. Hi my name is waleska ma husband has a pit and its always draining and white stuff comes out of it. He told me that he was born with it and it always has a bad smell will he have to get surgery or not.
    Thnx

    ReplyDelete
    Replies
    1. It is better to get the preauricular sinus operated by an experienced ENT surgeon in your area

      Delete
  14. Hi Dr. Sonia,
    My 12yr old daughter has a pit on each side but she has never had any issues with them. Do I still need to look into having them removed if they do not bother her?
    Thank you.

    ReplyDelete
    Replies
    1. Dear Shelly Preauricular sinuses can get infected that is why doctors recommend surgical removal.

      Delete
  15. hi there...
    i am 6 weeks pregnant and have sever pain and swelling in that pit...i went to the dr and she has prescribed me an antibiotic to take...its my second day taking them but i feel no difference in pain...i am very worried if this does not heal what will be the next step taken..as i am dealing with my pregnancy at this time...and i guess i cannot go with the surgery..Kindly advice me..
    thank you

    ReplyDelete
    Replies
    1. Madeeha if the medicines dont work your doctor will have no option but to drain the pus .All the best

      Delete
  16. Hi I am a 23 year old female and I have preauricular pits on both sides. A few days ago i woke up to the right side pit swollen and painful. It hurts to even lay on that side. This is the first time i have ever had any problems with these. Im not sure if it will go away on its own or if i should see a dr?

    ReplyDelete
    Replies
    1. Erin you have to see an ENT surgeon as swelling and pain means it has got infected. You will need antibiotics and if an abscess has formed it may need to be drained
      All the best

      Delete
  17. Dear Doctor,
    I have questions regarding re occur of the preauricular Sinus.
    I am looking for the surgury

    ReplyDelete
    Replies
    1. Dear Mr Prashant if the sinus tract has not been fully excised it recurs. So the surgery has to be done by an ENT surgeon well versed with this condition

      Delete
  18. Dear Doctor, i have 2 preauricular Sinuses, one above each ear, neither of which has ever become infected, would you still advise me to get surgery to remove them?

    ReplyDelete
    Replies
    1. Yes since its advisable to get it operated before it gets infected.

      Delete
  19. I first had a huge infection when I was 12 and the doctor at that time numb my cyst and called it a tumor cyst. The He perform to pop it, which he succeeded and now I am 31 and after 31 years; it has came back because I accidentally pressed a device on the area. Mine is now infected and swollen since this afternoon.I am on google trying to find information on this and I am very amused to find a lot f information. I prefer no surgeries. I have looked up and ENT doctor for appointment tomorrow. Is there any home remedies for controlling the redness? So i can take precaution next time.

    ReplyDelete
    Replies
    1. You have to meet your ENT Surgeon..no home remedies recommended!!

      Delete
  20. Help me im 13 and I have an infection it's really painful to touch and it brused and swollen lots and today I went to the hospital with my dad and they seemed not to know what it is and just gave us anti biotics to clear the infection but I don't think it will help will it ?Also my parents really want me to squeeze it but its really painful too they don't understand and when my mum squeezed it I cryed it was so painful should I squeeze it and just try to deal with the pain ?

    ReplyDelete
    Replies
    1. Dear Shauna
      Do not squeeze or try to burst it on your own if the antibiotics are not helping see your ENT again as it may need to be drained and later an operation performed to completely excise the pit and its tract

      Delete
  21. I'm presently suffering from preauricular abcess towards the exterior part of my ear. Of late, the frequency of such infections has risen. This is happening to me with a gap of every 5-6 months. This has happened thrice now and on all those occassions I had to undergo the incision and drainage procedure and it was very painful. Does one have to undergo this procedure for such infections or can the infection burst on its own. Is it possible for the infctions to burst and can one skip the incision and drainage procedure. Please advise.

    Regards,
    Anushka

    ReplyDelete
    Replies
    1. If they dont respond to antibiotics , an infected abscess needs to be drained and later go for a definitive surgery as advised by your ENT Surgeon

      Delete
    2. Okay, thanks

      Regards,
      Anushka

      Delete
  22. hello doctor,
    i have a daughter of 15 months, with preauricular sinus on her right ear,it got infected 2 months back , after showing it to doctor, he suggested some antibiotics,but it did not subside and formed into abscess, which we had removed on his advice,
    but the wound did not heal from inside , so it's forming puss again ans again.
    then i showed it to an ENT surgeon , and he said it has to removed completely.
    my concerns are:
    1. can pus be stop by using antibiotics before the surgery?
    2. will the pus recurrence affects my child's health?
    3. what is an prelimanary care i can take for pus to delvelop again and again
    thanks

    ReplyDelete
  23. hello doctor,
    my daughter of 15 months is already be treated for drainage of the pus but unfortunately it pus is recurring i donno why?

    please suggest help

    ReplyDelete
    Replies
    1. Just treating the infection is not the cure..the sinus and tract needs to be excised by your ENT surgeon

      Delete
  24. Dear doctor, my poor friend daughter age 12 , gone through a pre auricular tumour operation surgical . End out insurance company rejected the claim with reason this
    disease is congenital.
    My question is is it pre auricular is 100% congenital ? Or there have 1% chances to argue with it ? The poor family need the insurance claim payout to reduce their burden. Thanks

    ReplyDelete
  25. Preauricular sinuses are congenital and wont be covered in insurance. Disease such as TB can produces sinuses but you will need to furnish evidence of the same via histopathology of the excised sinus tract

    ReplyDelete
  26. Hi doctor. I'm 15 years old & I have a preauricular pit . It leaks yellow puss EVERY SINGLE DAY for as far back as I can remember . I didn't know exactly what it was until now . Today, my left ear is especially swollen/sore & I would just like to know why it leaks every day & of there is anything I can do to stop it or to heal the swelling without surgery

    ReplyDelete
    Replies
    1. Preauricular sinses get easily infected and discharge pus that is why once the infection subsides it has to be operated. While infected antibiotics and antiinflammatory medicines are usually prescribed.

      Delete
  27. This may be a dumb question, but could it mess with my hearing by any chance?

    ReplyDelete
    Replies
    1. Kathryn It need not but if in doubt have an audiometry test done

      Delete
  28. Hello Dr. My daughter had a cyst, but had surgery to remove it when she was a baby. I now have a friend who has a 9 yr old daughter who also has one. Her cyst is infected and currently is on day 7 of a second round of antibiotics. Today the site was so swollen and grew GREATLY within 3 hours. Her parents manually removed the pus, but they are concerned that they medicine is not working to rid her of the infection. What should they do? their ENT is currently out of town.

    ReplyDelete
    Replies
    1. Sometimes antibiotics dont work especailly if an abscess has developed.Do get the child seen by an ENT surgeon or at least a pediatric surgeon

      Delete
  29. Dear mam

    This is Rajesh from Chennai ,My daughter is affected by pre auricular sinus its get infected two times ,

    I checked with ENT surgeon they adviced me surgical removal is the treatment

    My daughter age is 1year 6 months .

    Doctor given the antibiotics to cure the infected sinus, now its look like normal skin.

    Please help me with your advice whether i can go ahead with surgery

    Normally how many stiches & how many days it will take to cure completely after the surgery.

    During night sleep she will turn a lot becuase of this stiches will affect



    Regards
    Rajesh

    ReplyDelete
    Replies
    1. Dear Mr Rajesh please go ahead with the surgery but the questions you have asked regarding stitches etc have to be asked to your surgeon as each surgeon will have a different technique
      All the best
      Dr Sonia S V

      Delete
  30. Hello Doc. I have a preauricular infection that seems to be getting worse. I am on antibiotics for two days npw but the pain keeps getting worse. The swelling area looks
    Iike its getting purple and I just noticed a bump under my skin behind my ear on that same side just where the ear ends. What should I do I am concerned because I have a 7 month old who I breast feed is this dangerous for him?
    Thank you for your time

    ReplyDelete
    Replies
    1. If the pain is worse even after 2 days of antibiotics you need to go back and see your doctor

      Delete
  31. My son has healed well from his left preauricular sinus tract excision. However, this happened months ago and and doesn't really complain for pain nor does it swell anymore. My problem is, his eating pattern has changed since the surgery. He used to be a hearty eater and now we have to force him to eat every day. Is there any connection to the surgery? Or is this a phase? Thank you in advance.

    ReplyDelete
    Replies
    1. How old is your son? Preauricular sinus surgery specifically need not have an effect on your son's eating. If you are worried show him to your paediatrician to make sure everything is alright

      Delete
  32. Hello Doc. I have a preauricular infection, I think...its swollen but no redness, has a bump tender sensation, painful to touch, having difficulty on my jaws, painful in lowering my head and slept on it...the difference is it has no pit/holes that seems to be getting worse now. I already notice this when I was younger, smaller than today and sometimes its hurt when I'm not feeling well or sick. I am on antibiotics since yesterday but still the same and I'm having an ear ache now. What should I do? is it really a preauricular infection?.
    Thank you for your time

    ReplyDelete
    Replies
    1. Thank you for writing Lee.If antibiotics are not working in 48 hrs you need to go back and show your ENT doctor

      Delete
  33. I was born with this pit in both ears had surgery when I was baby cause I was off balance then was fine after. Im now 31 and get ear infections like crazy in both ears can it be cause of this??

    ReplyDelete
    Replies
    1. Trenda if the ear discharge is coming from within the ear canal it need not be related to the preauricular sinuses

      Delete
  34. Hey doc, I'm a 13 yr old female and I have a preauricular pit on my right ear and it discharges once in a while. Is it alright if I was to go swimming ? And will my Medicare be able to cover the surgery cost or at least partially. I live in CA

    ReplyDelete
  35. Gina normally insurance companies dont cover congenital conditions but you could always ask your particular insurance personnel. As long as the water is clean swimming is not contraindicated

    ReplyDelete
  36. Hi! Mam, I'm a 45 yrs old male and having preauricular pits on both ears. For the past one year or so the left year seems infected and pus oozes out and the front of the year has swelled a bit. So today i consulted a local ENT specialist who has advised me antibioytcs and then suggested surgery for both the ears. I want a second opinion about the surgery whether i should go forward on both the ears or only the one which is infected .

    ReplyDelete
    Replies
    1. Dear Mr Vivek Thank you for writing to me. Both side preauricular sinuses have to be operated- you can do at the same time or as a staged process

      Delete
    2. hi im annelise i have preauricular pit and i am 10 and female and a infection how long do i have to have the stitches and be in the hospital plz write back.

      Delete
    3. Annelise generally stitches are removed in 7 days time and it can be done as a day care procedure which means you dont have to stay in the hospital at all. But surgeons and hospitals differ so please do discuss with your surgeon

      Delete
  37. My daughter is 17 years old. She has Branchio-Oto-Renal Syndrome. She has ear pits (as discussed above) on both ears. One of them discharges fluid regularly. About a month ago, that ear pit became infected (sore, red, swollen, discharging different fluid). She has had 2 different rounds of antibiotics from the pediatrician. She went to an ENT today and was given a different antibiotic, because it is still infected. The ENT said that she should have surgery to remove the ear pits after the infection is gone. I noticed that in the beginning of this discussion you said to "rule out" this type of syndrome. Should/could the ear pits be removed surgically for a person with Branchio-Oto-Renal Syndrome or would the surgery be different or do you know? Any suggestions? Thanks for your help.

    ReplyDelete
    Replies
    1. Dear Marcia Thank you for writing in ..yes the preauricular sinuses have to be removed in Branchio otorenal syndrome too

      Delete
  38. My daughter had a pit removed appr 12 years ago. Now she has swelling and tenderness in the same area of the previous excision. Is it possible for the pit to reoccur?

    ReplyDelete
    Replies
    1. Yes Dee it is possible for it to recur if it had not been completely removed. Do visit your local ENT Surgeon for an opinion as tenderness means there is some inflammation going on

      Delete

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