A preauricular pit is a small hole in front of the ear, toward the face, that some people are born with. This hole is connected to an unusual sinus tract under the skin. This tract is a narrow passageway under the skin that can cause infection.

Preauricular pits go by many names, including:

  • preauricular cysts
  • preauricular fissures
  • preauricular tracts
  • preauricular sinuses
  • ear pits

This tiny hole in front of the ear usually isn’t serious, but it can sometimes become infected.

Preauricular pits are different from brachial cleft cysts. These can occur around or behind the ear, under the chin, or along the neck.

Read on to learn more about why this small hole in front of the ear appears and whether it requires treatment.

Preauricular pits appear at birth as tiny, skin-lined holes or indents on the outer part of the ear near the face. While it’s possible to have them on both ears, they usually only affect one. In addition, there may be just one or several small holes on or near the ear.

hole in earShare on Pinterest
A preauricular pit, also called a preauricular sinus, is a common congenital condition that leaves a small hole in the front of the ear.

Aside from their appearance, preauricular pits don’t cause any symptoms. However, sometimes they become infected.

Signs of an infection in a preauricular pit include:

  • swelling in and around the pit
  • fluid or pus drainage from the pit
  • redness
  • fever
  • pain

Sometimes, an infected preauricular pit develops an abscess. This is a small mass filled with pus.

Preauricular pits occur during the development of an embryo. It most likely occurs during the formation of the auricle (the outer part of the ear) during the first two months of gestation.

Experts think the pits develop when two parts of the auricle, known as the hillocks of His, don’t properly join together. No one’s sure why the hillocks of His don’t always join together, but it may be related to a genetic mutation.

A doctor will usually first notice preauricular pits during a routine examination of a newborn. If your child has one, you may be referred to an otolaryngologist. They’re also known as an ear, nose, and throat doctor. They’ll closely examine the pit to confirm the diagnosis and check for any signs of infection.

They might also take a close look at your child’s head and neck to check for other conditions that may accompany preauricular pits in rare cases, such as:

  • Branchio-oto-renal syndrome. This is a genetic condition that can cause a range of symptoms, from kidney issues to hearing loss.
  • Beckwith-Wiedemann syndrome. This condition can cause abnormal earlobes, an enlarged tongue, and problems with the liver or kidneys.

Preauricular pits are usually harmless and don’t require any treatment. But if the pit develops an infection, your child may need an antibiotic to clear it up. Make sure they take the full course prescribed by their doctor, even if the infection seems to clear up before then.

In some cases, your child’s doctor may also need to drain any extra pus from the infection site.

If a preauricular pit repeatedly becomes infected, their doctor might recommend surgically removing both the pit and the connected tract under the skin. This is done under general anesthesia in an outpatient setting. Your child should be able to return home the same day.

After the procedure, your child’s doctor will give you instructions on how to care for the area after surgery to ensure proper healing and minimize the risk of infection.

Keep in mind your child may have some pain in the area for up to four weeks, but it should gradually get better. Closely follow the instructions for aftercare.

Preauricular pits are usually harmless and typically don’t cause any health issues. Sometimes, they become infected and require a course of antibiotics.

If your child has preauricular pits that regularly become infected, your child’s doctor may recommend surgery to remove the pit and connected tract.

Very rarely are preauricular pits part of other more serious conditions or syndromes.