A preauricular pit is a small hole in front of the upper ear, located just between the face and the cartilage of the ear rim.

A preauricular pit may occur on one or both sides of the ear. It is a common birth abnormality.

Most people with this type of hole in the ear do not experience additional symptoms. However, the pit can occasionally become infected, which requires antibiotic treatment. In cases of recurrent infection, surgery may be necessary.

Read on to learn more about preauricular pits, including their causes and treatment options.

a preauricular pit. Image credit: Klaus D. Peter, 2013.Share on Pinterest
A preauricular pit is a common birth abnormality.
Image credit: Klaus D. Peter, 2013.

A preauricular pit is a common birth irregularity first reported in 1864. Healthcare professionals tend to notice these pits during routine examinations of newborns.

These pits may occur on one or both ears, and there may be more than one pit present. However, it is more common for there to be a pit in only one ear.

The hole is connected to a sinus tract that should not be there. This tract runs under the skin, and its path can either be short or long and complicated.

Preauricular pits are not the same as preauricular tags, which are fleshy lumps of skin that carry no risk of complications.

According to research by the American Academy of Family Physicians (AAFP), preauricular skin lesions, including pits and tags, affect between five and 10 babies in every 1,000 live births.

In general, these holes are minor irregularities that do not cause serious complications. However, some people develop an infection in the pit and the sinus tract. Sometimes, an abscess may form at the site of the pit. Recurrent infections may require surgery.

On rare occasions, a preauricular pit appears as a feature of another condition, such as Beckwith-Wiedemann syndrome or branchio-oto-renal syndrome. Beckwith-Wiedemann syndrome is an overgrowth syndrome that affects many parts of the body. Branchio-oto-renal syndrome is a genetic condition that causes tissue anomalies in the ears, neck, and kidneys.

Preauricular pits are not the same as brachial cleft cysts, which occur along the neck, under the chin, or around the ear.

Other names for a preauricular pit include preauricular fissure and preauricular sinus.

Preauricular pits form during development in the uterus. They likely result from imperfect fusion of the auricle, which is the visible part of the ear. The auricle forms during the sixth week of gestation.

The pits may be inherited, which means that they can run in families. They may also be sporadic and occur for an unknown reason. If the condition affects both ears, it is more likely to be an inherited irregularity.

The incidence of preauricular pits varies. The AAFP report that up to 1% of babies have preauricular skin lesions. Other sources state that the incidence is as high as 10% in some parts of Africa.

Preauricular pits do not typically cause serious problems. The main risk is the risk of infection and development of a cyst, which can cause:

  • fever
  • fluid drainage from the hole
  • pain
  • redness
  • swelling

An abscess may form in an infected preauricular pit. An abscess is a small, painful lump that contains pus.

One study in young adult men with preauricular pits found that up until adulthood, around 25% of the holes developed symptoms. The most common symptom was recurrent sinus discharge.

Learn more about chronic sinusitis here.

People with one or more preauricular pits will likely need to see an otolaryngologist, also known as an ear, nose, and throat doctor. These doctors specialize in issues such as preauricular pits.

A preauricular pit does not usually require treatment unless it develops an infection. People who experience any symptoms of infection should see their doctor without delay. This infection is very close to the brain and must receive prompt medical treatment to prevent complications.

A person will typically require antibiotic treatment to clear up the infection. If an abscess develops that does not respond to antibiotics, however, a doctor may perform a needle aspiration to drain the pus from the abscess. They may also examine the bacteria present in the pus to determine if other antibiotics might work better.

If a needle aspiration is unsuccessful, a doctor may need to make an incision in the abscess and drain the pus.

Recurrent infections may require surgical removal of the pit and the connecting sinus tract. A person undergoing this type of surgery will receive a general anesthetic before the procedure begins. The surgery, which will take place in an outpatient facility, takes up to 60 minutes.

After the surgery, the doctor will provide information on pain management, infection prevention, and other aspects of aftercare. Full recovery takes several weeks.

The surgeon will usually wait to perform the procedure until the site is free of infection and swelling.

A hole in front of the upper ear, or a preauricular pit, is a relatively common birth abnormality. On rare occasions, it can indicate the presence of a syndrome.

That said, most cases are not a cause for concern. People with one or more preauricular pits are typically otherwise healthy.

Treatment or removal of a preauricular pit is not necessary unless an infection develops. When this happens, the infection requires immediate treatment with antibiotics.

Recurrent infections may require the surgical removal of the pit and connecting tract.