Do you have a small hole immediately in front of one or both of your ears?
Only 0.1-0.9% of the population have these holes, known in the medical community as “preauricular pits.”
Doctors sometimes refer to them by other names, including ear pits, preauricular tracts, preauricular cysts, preauricular sinuses, and preauricular fissures. Some people call them “dimples” or “dents.”
They first described in medical literature by German scientist Van Heusinger, in 1864.
A pit is an extra sinus tract immediately under the skin.
The small hole marks the opening of this extra tract. Preauricular pits are more commonly seen on the right side of the head, and they are slightly more frequent in women than men.
Very occasionally, they appear beneath the ear, close to the lobe.
Pits can be short or long.
What causes preauricular pits?
Preauricular pits are a congenital malformation, meaning that they form during gestation.
The outer part of the ear, the auricle, is formed six weeks after conception.
When the auricle doesn’t fuse properly, the baby will be born with a preauricular pit or other abnormality of the ear.
There isn’t a strong genetic basis for these pits, but the presence of pits on both sides of the head is more suggestive of a family history.
How are preauricular pits diagnosed?
The holes are present from birth, so many be diagnosed by visual examination within the first few hours of life.
However, because they are small and often asymptomatic, they aren’t always noticed immediately.
Whether they are noticed by a parent or doctor, the next step is to get them evaluated by an otolaryngologist.
The otolaryngologist will carry out tests to determine whether the pits are accompanied by any less obvious symptoms, such as inner ear and kidney abnormalities, that might indicate additional health conditions or complications.
If a child has other outer ear abnormalities, they will be given a hearing test.
Are preauricular pits often confused with other problems or conditions?
Preauricular pits should not be confused with branchial cleft cysts or preauricular tags. Branchial cleft cysts are masses found on a child’s neck, or near their collarbone.
They sometimes have an opening that resembles a dimple.
They often require antibiotic treatment, drainage, and removal.
Surgery is usually successful, but the cyst may recur.
Preauricular tags are harmless papules that are found near the ear.
They do not have a skin opening, and are not connected to a tract beneath the skin’s surface.
They are sometimes described as “fleshy knobs.”
They do not pose any health risks, although some people choose to have them removed for cosmetic reasons.
Are preauricular pits associated with any other health problems?
If a preauricular pit is accompanied by additional pits in the neck, hearing loss, and abnormal kidney functioning, this indicates branchio-oto-renal (BOR) syndrome.
The syndrome, which is caused by genetic mutations, can vary greatly in severity.
Some children are relatively unaffected, whereas others may require a kidney transplant or renal dialysis.
The majority (80%-99%) of people with this diagnosis have a hearing impairment, and 30%-79% have inner ear abnormalities.
If a baby has an unusually large tongue plus asymmetrical earlobes, they may have Beckwith-Wiedemann Syndrome.
It is an overgrowth syndrome seen in 1 in 15,000 births.
Symptoms include noticeably above-average height and weight, asymmetric growth, low blood sugar in the first few days following birth, and abdominal wall abnormalities.
Do preauricular pits cause any problems later in life?
Most people find that these pits cause them no trouble.
They are not associated with hearing problems.
They are small, so they aren’t usually a cosmetic issue either.
However, there is a risk of infection from pus-filled abscesses in the tract.
These require antibiotic treatment, drainage, or both.
If an individual suffers repeat infections, doctor will recommend that the tract be surgically removed.
This is done under general anaesthesia and can be a complex operation, depending on the size of the pit.
In some cases, an individual may develop cysts in the tract, which can cause discomfort.
Surgery may be required to remove them.
A surgeon will wait until all signs of infection have cleared up before operating.
When to see a doctor
If you have a preauricular pit and notice any swelling, redness, itchiness, or discharge near your ear, make an appointment with your doctor.
You should also see a medical practitioner if you have a painless lump near the pit, because you may be developing a cyst that requires surgical removal.
Otherwise, there is no need for concern.