Preauricular sinus and cyst

{{Infobox medical condition (new) | name = Preauricular sinus and cyst | synonyms = '''Congenital auricular fistula''', '''Congenital preauricular fistula''', '''Ear pit''',<ref name="Fitz2">{{cite book | first1 = Irwin M | last1 = Freedberg | first2 = Thomas B | last2 = Fitzpatrick | name-list-style = vanc | year = 2003 | title = Fitzpatrick's Dermatology in General Medicine | edition = 6th | publisher = McGraw-Hill | isbn = 978-0-07-138076-8 }}</ref>{{rp|782}} or a '''Preauricular cyst'''<ref name="Bolognia">{{cite book | last1 = Rapini | first1 = Ronald P. | last2 = Bolognia | first2 = Jean L. | last3 = Jorizzo | first3 = Joseph L. | name-list-style = vanc | title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref> | image = Preauricular sinus.jpg | caption = Preauricular sinus on right ear | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = | alt = }} '''Preauricular sinuses''' or '''preauricular pits''' and '''preauricular cysts''' are common congenital malformations of the external ear. The difference between them is that a cyst does not connect with the skin, but a sinus does. <ref>Thatcher, A.L. (2022). Congenital and inflammatory neck masses in children. In M. Lesperance (Ed.), ''Cummings Pediatric Otolaryngology, 23'', 308-321. </ref> Frequency of preauricular sinus differs depending on the population: 0.1–0.9% in the US, 0.9% in the UK, and 4–10% in Asia and parts of Africa.<ref>{{cite journal | vauthors = Kim HJ, Lee JH, Cho HS, Moon IS | title = A case of bilateral postauricular sinuses | journal = Korean Journal of Audiology | volume = 16 | issue = 2 | pages = 99–101 | date = September 2012 | pmid = 24653881 | pmc = 3936561 | doi = 10.7874/kja.2012.16.2.99 }}</ref>

Preauricular sinuses are inherited features, and frequently appear next to both ears.<ref>Moore, K.L., Persaud, T.V.N., & Torchia, M.G. (2010). Development of eyes and ears. ''Before we are born'', ''17'', 257-268.e1.</ref> Preauricular sinuses can be associated with other defects that are not visible, one example being branchio-oto-renal syndrome.<ref>{{Cite web |last=MedlinePlus Genetics [Internet] |date=18 August 2020 |title=Branchiootorenal/branchiootic syndrome |url=https://medlineplus.gov/genetics/condition/branchiootorenal-branchiootic-syndrome/#:~:text=Branchiootorenal%20(BOR)%20syndrome%20is%20a,members%20of%20the%20same%20family. |access-date=16 March 2022 |website=MedlinePlus}}</ref>

==Presentation==

=== Complications === Occasionally a preauricular sinus or cyst can become infected.<ref name="Andrews">{{cite book | last1 = James | first1 = William D. | last2 = Berger | first2 = Timothy G. | name-list-style = vanc |title=Andrews' Diseases of the Skin: Clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}</ref> Most preauricular sinuses are asymptomatic, and remain untreated unless they become infected too often.<ref>{{cite book | first1 = Stephen | last1 = Ludwig | first2 = Stephan | last2 = Strobel | first3 = Stephen D. | last3 = Marks | first4 = Pete K. | last4 = Smith | first5 = Magdi H. | last5 = El Habbal | first6 = Lewis | last6 = Spitz | name-list-style = vanc | url = https://books.google.com/books?id=s8XdO4wM1QQC | title = Visual Handbook of Pediatrics and Child Health | publisher = Lippincott Williams & Wilkins | date = 2008 | page = 517 | isbn = 978-0-7817-9505-0 }}</ref> These sinuses or pits can be excised surgically, but often present a high risk of recurrence.<ref>{{cite journal | vauthors = Leopardi G, Chiarella G, Conti S, Cassandro E | title = Surgical treatment of recurring preauricular sinus: supra-auricular approach | journal = Acta Otorhinolaryngologica Italica | volume = 28 | issue = 6 | pages = 302–5 | date = December 2008 | pmid = 19205595 | pmc = 2689545 }}</ref>

Those with preauricular sinuses frequently report an intense itch and urge to rub, press, or scratch the affected area, which often results in a foul-smelling, mucoid, or purulent discharge.<ref>{{Cite journal |last1=Dutta |first1=Mainak |last2=Ghatak |first2=Soumya |last3=Sarkar |first3=Rahul |date=2014 |title=Of periauricular pits and sinuses: understanding the masqueraders |journal=Einstein (Sao Paulo, Brazil) |volume=12 |issue=1 |pages=132–133 |doi=10.1590/s1679-45082014ai3020 |issn=2317-6385 |pmc=4898253 |pmid=24728260}}</ref> Ear pits may also involuntarily "leak" or drain on occasion. These undesirable effects lead many to be self-conscious about having the unique condition.

The presence of discharge is from a combination of factors, such as the accumulation and entrapment of dead skin cells, bacteria, and other debris.<ref>{{Cite web |title=Patient Education – Preauricular Sinus Tract |url=https://www.drcolinhong.com/patient-education-preauricular-sinus-tract/ |access-date=2026-05-15 |website=Dr. Colin Hong |language=en-US}}</ref> There is an element of the body's natural defense mechanisms involved as well, given that many experience the presence of serous exudate and formation of a tiny scab covering the pit hole. While the body is naturally protecting the preauricular sinus from foreign invaders, it is also believed to be attempting to heal the opening, which does not occur due to the condition being congenital.<ref>{{Cite journal |last1=Xu |first1=Ying |last2=Seng |first2=Dongjie |last3=Jiang |first3=Lan |last4=Wang |first4=Shengcai |last5=Ni |first5=Xin |last6=Zhang |first6=Jie |last7=Han |first7=Fugen |date=2020 |title=Summary of the Experience in the Diagnosis and Treatment of Complex Preauricular Fistulas in 78 Children |journal=Frontiers in Surgery |volume=7 |article-number=609852 |doi=10.3389/fsurg.2020.609852 |doi-access=free |issn=2296-875X |pmc=7882734 |pmid=33598478}}</ref>

While some are prone to insert foreign objects into the external opening (hole), this is discouraged to prevent potential trauma and infection.<ref>{{Cite web |last=ENT_kids |date=2025-03-25 |title=Preauricular Cysts and Ear Cysts |url=https://ent4kids.nz/preauricular-cysts-and-ear-cysts/ |access-date=2026-03-19 |website=ENT 4 Kids |language=en-NZ}}</ref>

== Causes == Preauricular sinuses and cysts result from developmental defects of the first and second pharyngeal arches.<ref>{{cite web |url= http://www.wrongdiagnosis.com/medical/preauricular_sinus.htm|title= Preauricular Sinus|access-date= 24 Feb 2009| work = Stedman's Medical Spellchecker | quote = cited in WrongDiagnosis.com|year= 2006 }}</ref> This and other ear malformations are sometimes associated with renal anomalies.<ref>{{cite journal | vauthors = Wang RY, Earl DL, Ruder RO, Graham JM | title = Syndromic ear anomalies and renal ultrasounds | journal = Pediatrics | volume = 108 | issue = 2 | pages = E32 | date = August 2001 | pmid = 11483842 | doi = 10.1542/peds.108.2.e32 | doi-access = free }}</ref> In rare circumstances these pits may be seen in genetic conditions such as branchio-oto-renal syndrome; however these conditions are always concurrent with other health concerns.<ref>{{cite web | title = Branchiootorenal syndrome | url = https://rarediseases.info.nih.gov/diseases/10147/branchiootorenal-syndrome | work = Genetic and Rare Diseases Information Center (GARD) | access-date = 2018-07-05 | archive-date = 2018-07-05 | archive-url = https://web.archive.org/web/20180705233028/https://rarediseases.info.nih.gov/diseases/10147/branchiootorenal-syndrome | url-status = dead }}</ref>

== Treatment == Courses of treatment typically include the following:<ref>{{Cite web |last=Philadelphia |first=The Children's Hospital of |date=2016-07-06 |title=Preauricular Pits |url=https://www.chop.edu/conditions-diseases/preauricular-pits |access-date=2024-04-15 |website=www.chop.edu |language=en}}</ref>

* Surgical excision is indicated with recurrent fistular infections,<ref>Dellinger, M.B., & Waldhausen, J.H.T. (2020). Head and neck sinuses and masses. In ''Holcomb and Ashcraft's Pediatric Surgery, 72'', 1171-1185.</ref> preferably after significant healing of the infection. In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. an otolaryngologist or a specialist General Surgeon. * The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.

== References == {{reflist}}

==Bibliography== {{refbegin}} * {{cite journal | vauthors = Leopardi G, Chiarella G, Conti S, Cassandro E | title = Surgical treatment of recurring preauricular sinus: supra-auricular approach | journal = Acta Otorhinolaryngologica Italica | volume = 28 | issue = 6 | pages = 302–5 | date = December 2008 | pmid = 19205595 | pmc = 2689545 }} * {{cite journal | vauthors = Kim JR, Kim DH, Kong SK, Gu PM, Hong TU, Kim BJ, Heo KW | title = Congenital periauricular fistulas: possible variants of the preauricular sinus | journal = International Journal of Pediatric Otorhinolaryngology | volume = 78 | issue = 11 | pages = 1843–8 | date = November 2014 | pmid = 25190621 | doi = 10.1016/j.ijporl.2014.08.005 | s2cid = 1885028 }} {{refend}}

== Further reading == {{refbegin}} * {{cite journal |vauthors=Tan T, Constantinides H, Mitchell TE |title=The preauricular sinus: A review of its aetiology, clinical presentation and management |journal=International Journal of Pediatric Otorhinolaryngology |volume=69 |issue=11 |pages=1469–74 |date=November 2005 |pmid=16125253 |doi=10.1016/j.ijporl.2005.07.008}} {{refend}}

== External links == *{{commonscatinline}} {{Medical resources | DiseasesDB = 34576 | ICD10 = {{ICD10|Q|18|1|q|10}} | ICD9 = {{ICD9|744.4}} | ICDO = | OMIM = | MedlinePlus = 003304 | eMedicineSubj = | eMedicineTopic = | eMedicine_mult = | MeshID = }} {{Congenital malformations and deformations of face and neck}}

Category:Cutaneous congenital anomalies Category:Congenital disorders of ears Category:Cysts