Preauricular Cysts, Pits, and Fissures Workup

  • Author: Samuel T Ostrower, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Aug 15, 2011
 

Laboratory Studies

Culture samples may be obtained during drainage procedures.

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Imaging Studies

  • Imaging is not indicated for routine preauricular cysts and sinuses.
  • Imaging is indicated in patients who present with pits or fistulas located in atypical regions, those with cartilage duplication around the external auditory canal that extends into the parotid, or those with recurrent parotid swelling. Sedation may be necessary in uncooperative or frightened children.
    • CT scans with contrast offer better bone definition, while MRI with contrast shows superior soft tissue delineation.
    • Ultrasound imaging may help the physician differentiate cysts, abscesses, and solid masses in this region, but it may not allow for complete analysis of the finer detail in small tracts and deeper fistulae.
  • Patients who have preauricular cysts or pits and a branchial cleft cyst should undergo a renal ultrasound to rule out branchio-oto-renal syndrome.
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Other Tests

Audiogram is not indicated in isolated preauricular cysts, pits or tags.

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Diagnostic Procedures

Needle aspiration may be performed in patients with infected lesions that have not responded to oral antibiotic therapy.

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Histologic Findings

Findings associated with ear pits include diffuse interstitial dermatitis, abundant foreign body reaction, and ruptured follicular cyst, epidermal cyst, and epidermal sinus tract.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Samuel T Ostrower, MD  Staff Physician, Department of Otorhinolaryngology, Albert Einstein College of Medicine

Samuel T Ostrower, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

John P Bent lll, MD  Associate Professor, Director of Medical Student Education, Departments of Otolaryngology - Head and Neck Surgery and Pediatrics, Albert Einstein School of Medicine; Director, Airway Clinic, Children's Hospital at Montefiore

John P Bent lll, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mitchell B Austin, MD  Director, Associate Professor, Department of Pediatrics, Division of Otolaryngology, Children's Medical Center, Medical College of Georgia

Mitchell B Austin, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Biavati, MD  Clinical Assistant Professor of Otolaryngology, University of Texas Southwestern Medical Center at Dallas, Southwestern Medical School; Private Practice, ENT Care for Kids, Dallas, TX

Michael J Biavati, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Peter S Roland, MD  Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director of Clinical Center for Auditory, Vestibular and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Adjunct Professor of Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Laryngological Rhinological and Otological Society, American Neurotology Society, American Otological Society, North American Skull Base Society, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Alcon Labs Honoraria Speaking and teaching; GSK Honoraria Speaking and teaching; Advanced Bionics Honoraria Board membership; Cochlear Corp Honoraria Board membership; Med El Corp travel grants Consulting

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Zou F, Peng Y, Wang X, et al. A locus for congenital preauricular fistula maps to chromosome 8q11.1-q13.3. J Hum Genet. 2003;48(3):155-8. [Medline].

  2. Scheinfeld NS, Silverberg NB, Weinberg JM, Nozad V. The preauricular sinus: a review of its clinical presentation, treatment, and associations. Pediatr Dermatol. May-Jun 2004;21(3):191-6. [Medline].

  3. Aronsohn RS, Batsakis JG, Rice DH, Work WP. Anomalies of the first branchial cleft. Arch Otolaryngol. Dec 1976;102(12):737-40. [Medline].

  4. Baarsma EA. Surgical treatment of the infected preauricular sinus. Arch Otorhinolaryngol. 1979;222(2):97-102. [Medline].

  5. Coatesworth AP, Patmore H, Jose J. Management of an infected preauricular sinus, using a lacrimal probe. J Laryngol Otol. Dec 2003;117(12):983-4. [Medline].

  6. Currie AR, King WW, Vlantis AC, Li AK. Pitfalls in the management of preauricular sinuses. Br J Surg. Dec 1996;83(12):1722-4. [Medline].

  7. Figueroa AA, Friede H. Craniovertebral malformations in hemifacial microsomia. J Craniofac Genet Dev Biol Suppl. 1985;1:167-78. [Medline].

  8. Firat Y, Sireci S, Yakinci C, et al. Isolated preauricular pits and tags: is it necessary to investigate renal abnormalities and hearing impairment?. Eur Arch Otorhinolaryngol. Sep 2008;265(9):1057-60. [Medline].

  9. Gur E, Yeung A, Al-Azzawi M, Thomson H. The excised preauricular sinus in 14 years of experience: is there a problem?. Plast Reconstr Surg. Oct 1998;102(5):1405-8. [Medline].

  10. Mallo M. Retinoic acid disturbs mouse middle ear development in a stage-dependent fashion. Dev Biol. Apr 1 1997;184(1):175-86. [Medline].

  11. Mandell DL. Head and neck anomalies related to the branchial apparatus. Otolaryngol Clin North Am. Dec 2000;33(6):1309-32. [Medline].

  12. O'Rahilly R. The timing and sequence of events in the development of the human eye and ear during the embryonic period proper. Anat Embryol (Berl). 1983;168(1):87-99. [Medline].

  13. Prasad S, Grundfast K, Milmoe G. Management of congenital preauricular pit and sinus tract in children. Laryngoscope. Mar 1990;100(3):320-1. [Medline].

  14. Rothschild MA, ed. Syndromic and Other Congenital Anomalies of the Head and Neck. Otolaryngol Clin North Am. Dec 2000;33(6).

  15. Smith RJ, Coppage KB, Ankerstjerne JK, et al. Localization of the gene for branchiootorenal syndrome to chromosome 8q. Genomics. Dec 1992;14(4):841-4. [Medline].

  16. Tan T, Constantinides H, Mitchell TE. The preauricular sinus: A review of its aetiology, clinical presentation and management. Int J Pediatr Otorhinolaryngol. Nov 2005;69(11):1469-74. [Medline].

 
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Preauricular ear tag. Image courtesy of Jack Yu, MD.
Multiple tags in a child with oculoauriculovertebral dysplasia. Note the hemifacial atrophy, retrognathia, and lower set ear. Image courtesy of Jack Yu, MD.
Uninfected preauricular pit. Image courtesy of Ed Porubsky, MD.
Close-up image of preauricular pit. Image courtesy of Ed Porubsky, MD.
Infected preauricular cyst with swelling and erythema toward the cartilage of the ear.
A preauricular sinus tract is probed with a blunt needle, and methylene blue dye is injected. Note the region in front of the pit, where previous abscess formation, spontaneous drainage, and residual scarring and granulation have occurred. This circumstance requires a more complex procedure. Removal of the entire sinus tract and the granulation disease is essential. Image courtesy of Ed Porubsky, MD.
Preauricular sinus tract, cyst, and granulation removed. The skin was closed with slight undermining and no tension. Sutures are removed 7-10 days later.
Keloid scar formed several months after removal of preauricular sinus tract. Intralesional steroids and close observation are indicated.
 
 
 
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