Does your child have a tiny hole near their ear? Here's what it is

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Check your children's ears now.

Parents, carefully observe your child’s ears, just where they join the face. Can you spot a tiny hole (as depicted by the picture above)?

This small hole is known as a preauricular pit. It also has other names, such as preauricular sinus or fistula. The hole arises from a problem in ear development during the sixth week of pregnancy.

Actually, this small hole is the entrance to a sinus tract which continuously intertwines under the ear’s skin. The sinus canal can be either short or long, with several branches forming zig-zag shapes across ear tissue.

Preauricular Ear Pit Baby: A Congenital Defect

preauricular ear pit baby

This innocent hole doesn’t usually cause problems, but if you notice something wrong, do consult a medical professional.

Neil Shubin, the Professor and Associate Dean of Biological Sciences at the University of Chicago, explains that the preauricular pit is an “evolutionary remnant of fish gills.” It goes without saying that just because you have this small hole, it does not make you (or your baby) a mermaid or an alien!

The preauricular pit was first documented by a scientist named Van Heusinger in 1964. Normally, this tiny hole is only found on one ear, but about 50% of people have them on both ears.

A preauricular hole near the ear actually counts as a congenital defect because usually, babies don’t have such holes.

These pits can also appear as a dimpling rather than a hole. Fortunately, this condition is quite rare — only about 5% of the global population have it. Both genders are similarly affected by the condition.

Furthermore, while not all relatives might have a preauricular pit, it is likely to run in the family if both of your child’s ears are affected. 

Note that there are certain ear conditions that can be mistaken for preauricular pits.

  • Preauricular tags are are mounds of skin near the ear. They don’t have a sinus tract and so are not at risk of an infection. At best, they are only “appearance problems” and won’t cause potential issues like preauricular pits. 
  • A branchial cleft cyst is a more serious condition which initially shows up as a small opening, skin tag, or dimpling around the neck. These cysts, which look like extra pouches of flesh, are at risk of becoming infected and needs to be drained.

Preauricular Ear Pit Baby and Potential Risks

Red Flags

Even though it’s rare, these holes can sometimes be associated with various ear infections and sinusitis. This is the reason why a pediatrician will refer your child to an ENT specialist if he is aware that your child has a preauricular pit. The ENT specialist will examine the child further to eliminate anything serious. 

Wiyarni Pambudi, a paediatric specialist and an International Board certified lactation consultant, says that preauricular holes don’t require medical attention and can be left as it is. However, there are some red flags to take note.

Not all children have identical symptoms, but here are common symptoms that require treatment from an ENT specialist:

  • Inflammation of the surrounding tissue near the preauricular pit.  
  • An infection, which is characterized by redness of surrounding tissue, pain, fever or swelling inside the and around the pit. 
  • Abscesses, which can appear with an infection. These are small masses filled with pus or an irritating fluid discharge, usually white or yellow in colour. 
  • Cyst formations. Cysts are painless lumps near the hole which expand slowly over time, as dirt accumulates near the hole. Unfortunately, cysts can heighten the risk of infection in the area.  

Although it’s near the ear, the preauricular sinus is not usually related to hearing problems. 

Congenital Syndromes Associated with Ear Pits

In rare cases, preauricular pits can jointly appear with a genetic syndrome — together with a whole host of other problems associated with that syndrome.

A newborn baby with such a congenital defect will be carefully analysed to see if the hole will present an additional risk.

Here are some syndromes that come with preauricular sinuses:

  • Beckwith-Wiedemann syndrome is a disease that usually presents with unsymmetrical earlobes and a tongue bigger than its normal size. Do get this checked right away, as the syndrome has been known to cause abdominal irregularities and cancers of the kidney and liver. 
  • Branchio-oto-renal syndrome, which can be detected by:
    • pits seen around the neck with tags or pits in front of the ear
    • reduced hearing compared to normal
    • kidney abnormalities 

What Can I Do If I Notice This Condition? 

preauricular ear pit baby

Always let a medical professional assess your child. Do not self medicate.

The best course of action you can take if you see a preauricular pit is to consult an ENT specialist or otolaryngologist. They are experienced in their fields and can administer the best possible treatment procedure for your child.

The specialist will assess if your child’s ear pit is dangerous or not, checking the severity of infections, or if there are possible genetic syndromes.

They will perform imaging techniques (MRI, CT scans, ultrasounds scans) to help them develop a diagnosis and ascertain what the best course of action is. They may also use an audiogram to test your child’s hearing abilities if they have ear pits with irregularities observed in the external ear.

If your child does have other syndromic features, your doctor may recommend you to consult with other specialists. 

How Will the Doctor Treat My Child?

If your otolayngologist does find something requiring medical attention, they may perform at least one of the following, depending on the issue at hand:

  • Giving your child antibiotics if he suspects that the pit is infected.
  • Poking a needle into an abscess when antibiotics aren’t effective. The needle will allow the doctor to obtain cells and understand the bacteria causing the disease better. This technique is called needle aspiration.
  • Cutting open an abscess and draining it if needle aspiration fails.
  • Removing the whole tract by surgery if the preauricular pit gets infected too often. Parents can expect the surgery to take about one hour to complete after their child is anesthesised. As this is a minor surgery, it does not need to be done in a hospital. Surgeons normally only conduct the operation when the child has recovered from an infection.

What Happens After Treatment?

Once your child has received treatment for an ear pit infection, they will need to be closely monitored for further issues. If infections repeat, surgery is needed. Medical staff will advise parents to care for the bandaged wound, administer antibiotics, and schedule an appointment to follow-up on the child’s condition.

Surgical stitches will break down on their own, so not to worry. Do note that it is necessary for your child to keep his head raised while asleep and that he won’t be able shower while the wound is still bandaged. They should be fit enough for school, though. Just avoid activities that are too taxing, and the surgical wound will recover in no time. 

We at theAsianparent hope that this information regarding preauricular ear pit baby was helpful in relieving your concerns. If you suspect a serious medical condition, please consult a doctor.

References: Verywell Health, Blog Wiyarni , Business Insider, NeilShubin.com, Children’s Hospital of Philadelphia

Also read: 8 warning signs of hearing problems in children

                   Ear infections in kids: symptoms and how to treat them