This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
IntroductionPreauricular sinus, a common congenital malformation, is a tract or 'tunnel' that has an opening on the skin but has a longer blind-ended portion underneath the skin. It has an epithelial inner lining (i.e the inner coating of the tract) that is continuous with the skin opening, therefore predisposing it to infection. It is frequently noted on routine physical examination as small pit(s) - more than one may exist- adjacent to the external ear, usually at the front part of the ear pinna. Other locations are possible but much rarer. They are usually present at birth, but they usually become more apparent later in life.The sinus may occur on both ears (bilateral) in 25-50% of cases, and bilateral sinuses are more likely to be hereditary (Scheinfeld). In one-sided (unilateral) cases, it is commoner on the left side. Both men and women are equally affected in terms of frequency of cases.CausesThis condition is different from preauricular cyst or tags although they generally arise as a result of the branchial arch malformations. Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence, which includes preauricular sinuses (Wang R). Some cases of preauricular sinuses are associated with some congenital facial deformity syndromes, like Treacher Collins syndrome, branchio-oto-renal (BOR) syndrome and many other rare ones.EffectsPreauricular sinus itself does not directly cause or lead to any life-threatening conditions. In a lot of patients, it remains there without causing symptoms (so much so that the patients themselves and/or the people around don't even realise it is there !)However, in a fraction of patients, there is significant morbidity associated with preauricular sinus(es). This includes recurrent infection at the site, infection/inflammation spreading to the face (facial cellulitis) and ulceration with subsequent scarring. Infection may also take the form of chronic intermittent drainage of pus-like yellowish material from the opening. It may discharge for a few weeks before it subsides to recur again some time later. Draining sinuses are usually prone to infection. This may lead to redness over the opening and sometimes forming painful swelling over the opening. Some may resort to see their family physicians or their ENT doctors where antibiotics prescription is usually given out. Occasionally the swelling progresses to form small abscesses. Large abscesses can also develop as a result of local infection, sometimes requiring surgical drainage of the abscess. The scarring itself, with or without surgical intervention, can be disfiguring in chronic or severe cases.What to do ?While asymptomatic ones are best left alone, those infected ones are indicated for surgical removal. Once infection has occurred (even once!), the likelihood of subsequent recurrent acute exacerbations is high. The best solution is to have the entire sinus tract surgically removed as the definitive treatment.Surgery should be performed once any infection has been optimally treated with antibiotics and the inflammation has had time to subside. Be warned that an actively infected during the definitive surgery may have a higher tendency of recurrence. One should suspect incomplete removal of the sinus tract or recurrence if discharge from the sinus tract opening persists or recurs. Most recurrences occur early within the first few months. A prior incomplete attempt to remove the tract and/or preceeding surgical drainage for any abscess as a result of the local infection can also make the subsequent definitive surgical removal of the sinus tract difficult due to scarring changes, hence the higher recurrence rate in the future. Therefore early treatment of infected tract is advisable for better clinical outcome. The importance of a complete removal of the preauricular sinus tract cannot be overemphasized to prevent recurrence.References1.Scheinfeld NS, Silverberg NB, Weinberg JM, Nozad V. The preauricular sinus: a review of its clinical presentation, treatment, and associations. Pediatr Dermatol. May-Jun 2004;21(3):191-6.2.Wang R, Martinez-Frias ML, Graham JM Jr. Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: A case-based and case-control approach. J Pediatr. Nov 2002;141(5):611-7
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How many times have you actually taken a closer look at other’s or even your own ear (medical term = ear pinna) ? Have you ever noticed small slits or pit(s) in front of the usual opening (medical term = external ear meatus) to the canal ?
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)