Preauricular pits, sinuses, and tags are not unusual in the pediatric population and are often an incidental physical exam finding. Ear tags are flesh-colored appendages, and ear pits are small indentations, both most commonly located anterior and adjacent to the external ear. An ear pit may be the outermost sign of a sinus tract, which can be of variable length and may ultimately lead to the formation of a subcutaneous cyst. The prevalence of preauricular anomalies varies depending upon geographic location, ranging from 0.3% to 5% of the population, with the highest incidence in some areas of Asia and Africa. They may be sporadic or inherited, and bilateral findings are more commonly of the inherited type. When other craniofacial or physical anomalies are present, it is crucial to evaluate for genetic syndromes in which ear malformations are common, such as Treacher–Collins, Goldenhar, or Branchio-Oto-Renal (BOR) syndromes (see “Other Diagnoses to Consider” for complete list).

An isolated, asymptomatic preauricular pit, sinus, or tag requires no intervention. In contrast, a preauricular sinus that develops erythema, pain, swelling, or discharge due to acute infection should be treated with appropriate antibiotics, and recurrent or persistent infection requires surgical excision. While preauricular anomalies are generally benign conditions, a potential association with hearing loss and renal abnormalities exists. A number of studies show that children with preauricular anomalies may be at increased risk of hearing loss, particularly those with preauricular pits and tags as part of a syndrome. The evidence is inconclusive regarding the increased risk of renal anomalies in children with isolated preauricular sinuses, pits, and tags in the absence of a syndrome. Current guidelines suggest screening with renal ultrasound for children with preauricular anomalies only if they are associated with other malformations or dysmorphic features, a family history of deafness or auricular or renal malformations, or a maternal history of gestational diabetes.

• Preauricular pits and sinuses are generally asymptomatic but if infected, may present with swelling, pain, erythema, and discharge. A history of recurrent infection may warrant surgical intervention.

• Preauricular anomalies are often inherited, so family history is important to obtain. When inherited, the pattern is of incomplete autosomal dominance with reduced penetrance and variable expression. Bilateral preauricular pits and sinuses are more likely to be inherited than unilateral ones.

• While most ear pits and tags are incidental findings, they may be associated with genetic syndromes, so it is important to inquire about a history of other physical anomalies.

• Family and personal history of hearing loss must be obtained as preauricular pits and sinuses may be associated with a higher incidence of hearing impairment.

• Ear pits are small indentations located adjacent to the external ear, most often anterior to the helix, but may occur along the posterior margin of the helix, tragus, or ear lobe.

• A preauricular indentation may be the outermost sign of a sinus tract, which may branch or follow a tortuous route, and may ultimately lead to the formation of a cyst.

• Ear tags are flesh-colored appendages that may consist of skin, subcutaneous fat, and/or cartilage and are often located anterior to the tragus.

• Preauricular pits or sinuses may be unilateral, but 25% to 50% are bilateral. When unilateral, they are more commonly found on the right side.

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