When a baby is born, one of the first few things every parent does is to check on the gender, and count the baby’s fingers and toes. This universal action, considered an automatic reaction to determine whether the child is born ‘complete’ and flawless, is almost always met with deep sighs of relief as the majority of babies are born healthy.
Over time, however, attentive parents will start noticing little quirks that have gone initially unnoticed. Such as when the child does not respond to the parent’s voice, or cries very little, does not talk even after the age of two or others. These are signs of abnormality in the ear, nose or throat that usually manifest later, and parents need to be sufficiently connected to their child to realise that something is not right and seek medical advice.
One abnormality that is often missed in infancy, sometimes up to adulthood, is the preauricular pit, a small hole located close to the ear. Also known as preauricular cyst or sinus or Congenital auricular fistula in medical terms, it can be present in one or both sides of the face.
Although it looks like an innocent small hole on the skin surface, the preauricular pit can run deep within the tissues, going into the ear cartilage and skin tissue. They are usually connected to a deeper pocket and are usually lined with squamous epithelium (soft skin tissue).
What Causes It?
A preauricular pit happens when there is a faulty development in the ear while a child is still in the womb. For unknown reasons, the sinus tract failed to fuse completely, resulting in a small opening close to the ear. As such, a preauricular pit is a congenital condition that is already present when the child is born. It will not close up over time, although many parents hope it will.
Some children with the preauricular pit may also have other abnormalities such as small size, hearing loss and kidney problems, hence parents will need to be more vigilant with the child’s health. Generally, the only complication arising from preauricular pit is infection, which may get severe if not treated quickly.
Infection Of The Preauricular Pit
Common symptoms of an infection at the preauricular pit include bleeding, swelling, redness or discharge from the hole. Fever may or may not be present.
Smaller children may not know what is bothering them and may just cry or whine incessantly, complaining of pain around the ear or face.
There are no specific reasons why the infection happens – bacteria are all around us and it sometimes gets under the skin to cause problems such as rashes or acne.
In the same way, bacteria somehow managed to find its way into the preauricular pit, resulting in an infection.
Treatment with antibiotics is usually simple and effective if the infection is minor.
In severe cases, the infection is deeply ingrained, resulting in an abscess or cellulitis (infection in the deeper layers of the skin).
When this happens, the doctor will need to perform a small procedure to get the infection drained and treated.
In severe cases where there is a cyst or persistent infection, surgery may be recommended to clear the infection and seal off the pit to prevent further re-infection.
The surgery is done under general anaesthesia and on an outpatient basis, although an overnight stay is sometimes recommended for monitoring.
The operated area needs to be kept dry and clean for the following week to ensure quick recovery.
The Trouble With Insurance
As a preauricular pit is considered to be a congenital defect, any procedures related to it are not covered by insurance, even in the event of surgery due to abscess or bad infection. Although many ENT experts are of the opinion that the infection is not something that is congenital, in the same way ear infection is not inherited although the ear is present at birth, insurance agencies have yet to recognise preauricular infection as a claimable medical procedure.
As such, if you or your child has a preauricular pit infection, please be prepared to make arrangements for personal payment to avoid any unnecessary disagreements post-surgery.
Living With The Preauricular Pit
Fortunately, most people with the preauricular sinus do not face major problems with their little hole near the ear throughout their lives. Some may have minor infections now and then, which are easily treated if discovered early.
Once you notice your child has a preauricular pit, teach them from young to care for it the same way they care for their teeth. This includes keeping it clean by pressing the sides of the hole gently every week to remove any excess sebum (oil), and avoiding applying heavy make-up or skincare products on it to avoid clogging the hole.
The stuff that comes out may smell a little, but that is fine as long as there is no redness or swelling at the surface that may indicate an infection. Consult a doctor immediately if there is an infection.
Some cultures around the world believe that people born with a preauricular pit are special, and in some ways it is true. Aesthetically, the little hole does not affect the overall appearance, but may add some allure to an individual’s face.