Pre-Auricular Sinus

Preauricular sinuses are common congenital malformations first described by Heusinger in 1864. They are frequently noted on routine physical examination as small dells adjacent to the external ear, usually at the anterior margin of the ascending limb of the helix. However, they have been reported to occur along the lateral surface of the helicine crus and the superior posterior margin of the helix, the tragus, or the lobule. Anatomically, they are lateral and superior to the facial nerve and the parotid gland.

Preauricular sinuses are inherited in an incomplete autosomal dominant pattern, with reduced penetrance and variable power of expression. They can arise spontaneously. The sinus may be bilateral in 25-50% of cases, and bilateral sinuses are more like to be hereditary. In unilateral cases, the left side is more commonly affected.

A few resources that may be helpful include the eMedicine article Preauricular Cysts, Pits, and Fissures, the Medscape Otitis Media Resource Center, and the Medscape CME courses Diagnostic Methods to Treat Ear Pain in Primary Care Setting and Antibiotics Not Recommended to Prevent Middle Ear Effusion in Children.

**Look at the small hole inside the star sign**

Surgical Care

Once infection occurs, the likelihood of recurrent acute exacerbations is high, and the sinus tract should be surgically removed. Surgery should take place once the infection has been treated with antibiotics and the inflammation has had time to subside. Controversy regarding indications for surgery exists. Some believe that the sinus tract should be surgically extirpated in patients who are asymptomatic because the onset of symptoms and subsequent infection cause scarring, which may lead to incomplete removal of the sinus tract and postoperative recurrences. The recurrence rate after surgery is 13-42% in smaller studies and 21% in one large study.