Preauricular Cysts, Pits, and Fissures Workup

Updated: Apr 19, 2018
  • Author: Samuel T Ostrower, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

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, and 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.

Ultrasonographic 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 renal ultrasonography to rule out branchio-oto-renal syndrome.

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Other Tests

Audiogram is not indicated in isolated preauricular cysts, pits or tags. This was backed up by a study by Wu et al, which suggested that in children with isolated preauricular lesions but no previous otologic surgery or hearing-loss risk factors, there may be no need for audiologic assessment, apart from regular hearing screening. Nonetheless, the investigators did report that eustachian tube dysfunction appeared to be more greatly associated with such patients. The study found that of 99 pediatric patients with preauricular lesions, 12 had abnormal hearing, including five with conductive hearing loss resulting from eustachian tube dysfunction. [7]

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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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