Preauricular Sinus Infection

According to Medline Plus, preauricular sinus refers to a small piece or clump of skin located in front of the outside part of the ear. It is caused by problems with an infant's sinus track. Infants born with this congenital defect normally don't have many problems with it; however, sinus infections are possible.

Basics

• Preauricular sinuses normally occur on only one of the two ears, but there are cases in which both ears have the defect. They are more common outside of the right ear for females. According to Leopardi et al., preauricular sinus rates in the United States and Europe are less than 1 percent in the general population. In Taiwan, its rate of occurrence is 2.5 percent. Some African regions have the highest rate of prevalence, with it occurring in almost one out of 10 people.

Cause

• Preauricular sinuses may arise from "a defect in the development of the first branchial arch during the sixth week of gestation," according to Leopardi et al. This theory supposes that preauricular sinuses emerge when the six auditory hillocks of His were not fused completely while the child was developing. The defect may occur from general changes that happen in gestation, or it occurs based on an individual's family history. Preauricular sinuses may be genetic. Infections of the sinuses are caused by bacteria and mucus buildup.

Treatment

• Treatment for severe preauricular sinus infections mainly includes taking antibiotics. The antibiotics given should kill the bacteria causing the infection. If there is an abscess or a boil, draining is necessary to eliminate the extra mucus built up. According to Tan et al., one option for drainage is to use a lacrimal probe to explore the sinus cavity and clear any built-up mucus. This method does not require any incisions along the sinuses.

Surgical Options

• In individuals who often have preauricular sinus infections, surgery may be an option to reduce their occurrence. According to Tan et al., the standard surgical procedure involves the removal of the skin around the sinus. Then, the preauricular sinus is removed from its tract. Another procedure may produce lower recurrence rates; however it is also more radical. In this procedure, a larger incision is made to explore more of the area. The prearuricular sinus is removed, but so is some of the tissue around it to completely remove any dead space around the sinus.

Considerations

• Though preauricular sinuses are normally asymptomatic and cause no problems for the individual, further examinations may be needed to ensure an infant's safety. According to Tan et al., further testing (specifically a renal ultrasound) normally occurs if the infant has any other malformations. Also, if the infant has a family history of deafness, an auricular or renal malformation, and/or a mother with gestational diabetes, then a renal ultrasound is recommended. Some studies report a correlation between the presence of preauricular sinuses and renal problems.