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Preauricular Cysts, Pits, and Fissures Workup

  • Author: Samuel T Ostrower, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 31, 2016
 

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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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, American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

John P Bent, III, MD Professor, Director of Pediatric Otolaryngology, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Albert Einstein School of Medicine; Director, Airway Clinic, Cochlear Implant Program, Children's Hospital at Montefiore

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for 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 Auditory Society, The Triological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Neurotology Society, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, 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, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

References
  1. An SY, Choi HG, Lee JS, Kim JH, Yoo SW, Park B. Analysis of incidence and genetic predisposition of preauricular sinus. Int J Pediatr Otorhinolaryngol. 2014 Dec. 78 (12):2255-7. [Medline].

  2. Lee KY, Woo SY, Kim SW, Yang JE, Cho YS. The prevalence of preauricular sinus and associated factors in a nationwide population-based survey of South Korea. Otol Neurotol. 2014 Dec. 35 (10):1835-8. [Medline].

  3. 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].

  4. Beleza-Meireles A, Hart R, Clayton-Smith J, et al. Oculo-auriculo-vertebral spectrum: Clinical and molecular analysis of 51 patients. Eur J Med Genet. 2015 Sep. 58 (9):455-65. [Medline].

  5. Andersen SL, Olsen J, Wu CS, et al. Severity of Birth Defects After Propylthiouracil Exposure in Early Pregnancy. Thyroid. 2014 Jun 25. [Medline].

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

  7. Coatesworth AP, Patmore H, Jose J. Management of an infected preauricular sinus, using a lacrimal probe. J Laryngol Otol. 2003 Dec. 117(12):983-4. [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. 2008 Sep. 265(9):1057-60. [Medline].

  9. Tan T, Constantinides H, Mitchell TE. The preauricular sinus: A review of its aetiology, clinical presentation and management. Int J Pediatr Otorhinolaryngol. 2005 Nov. 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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