What is That Hole Near My Child's Ear?

Preauricular Pits

Image of preauricular pit.

Preauricular pits or sinuses are small holes present in front of the ear and occur in 0.3% to 5% of the population. They are small skin lined tracks that lead from the skin surface to deep within the tissues in front of the ear. Their track course can go into the cartilage or end in the skin tissue. These preauricular malformations usually appear in isolation and are considered by some to be of minor clinical importance.

Preauricular ear pits can, however, be associated with other major cranio-facial anomolies, including outer ear and ear-canal malformations and/or genetic syndromes (eg, Treacher-Collins, Goldenhaar, or branchio-oto-renal [BOR] syndromes) that themselves may be associated with hearing impairment.

Why does a preauricular sinus or pit occur?
A preauricular sinus or preauricular pit occurs as a result of faulty fusion in the development of the ear while the child is in the womb so it is a congenital condition present from birth.

What does a preauricular sinus signify?
The presence of a preauricular sinus may be associated with:

  • Hearing Loss  A significantly higher prevalence of permanent hearing impairment was found among infants with preauricular skin tags or ear pits (8 of 1000), compared with infants without tags or pits (1.5 of 1000). In the low-risk group, the prevalence was 3.4 of 1000, compared with 0.5 of 1000 in infants with and without preauricular tags or pits, respectively. In the high-risk group, the prevalence was 77 of 1000, compared with 20 of 1000 in infants with and without preauricular tags or pits, respectively. The odds ratio for hearing impairment associated with preauricular skin tags and/or ear pits after adjusting for level of risk group was 4.9. Infants with preauricular skin tags or ear pits are at increased risk for permanent hearing impairment. Hearing should be tested at birth and monitored per the audiologist or ENT recommendations.
  • Other abnormalities of the outer ear:  asymmetry, orientation, small size, absent tragus, and narrow ear canal.
  • Inner ear abnormalities. Although the inner ear does not originate from the same tissue as the external ear, multiple ear malformations may be possible because of the close proximity of these tissues and because the inner ear and external ear develop at the same time of fetal development. Thus, isolated preauricular pits can possibly be a sign not only of abnormalities at the level of the outer and/or middle ear but also of the inner ear.
  • Syndromes-Branchio-oto-renal syndrome, Mandibulofacial dysostosis, Beckwith-Wiedemann syndrome (Pediatricians and ENT Surgeons should always rule out syndromes in a child with preauricular pits).

Does a preauricular pit close by itself?

No, a preauricular sinus or pit does not close by itself.

What complications can happen in a child or adult with a preauricular sinus?
A preauricular sinus is lined with skin cells and can get blocked and infected at any time. Infection can lead to abscess formation and cellulitis. A pit can also accumulate material and become a cyst.

The signs of an infected preauricular pit are redness, pain, swelling, and pus discharge. Infected preauricular pits need to be treated by a physician.  In some cases, especially if there are multiple infections, surgical removal is recommended.


  1. Firat Y, et al. Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment? Eur Arch Otorhinolaryngol 2008;265:1057-61.
  2. Kohelet D, Arbel E. A prospective search for urinary tract abnormalities in infants with isolated preauricular tags. Pediatrics 2000:105,e61.
  1. Deshpande SA, Watson H. Renal ultrasonography not required in babies with isolated minor anomalies. Arch Dis Child Fetal Neonatal Ed 2006:91,F29-F30.
  2. Roth DA, et al. Preauricular skin tags and ear pits are associated with permanent hearing impairment in newborns. Pediatrics 2008:122:4,e884.

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