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Pre-auricular Sinus
Learn symptoms, causes, management of pediatric pre-auricular sinus, and when to contact a pediatric surgeon in Singapore.
What Is Pre-auricular Sinus in Children?
Pre-auricular sinus is a small opening or pit located in front of the ear, typically near where the ear connects to the face. This tiny hole is present from birth and represents a minor developmental variation that occurs in approximately 1-2% of children. The opening on the skin surface connects to a narrow tract or tunnel that runs beneath the skin, which can extend toward the ear cartilage or deeper tissues.
Most pre-auricular sinuses are harmless and cause no problems throughout a person's life. However, the tract can sometimes trap dead skin cells, bacteria, and debris, leading to infection and requiring pre-auricular sinus excision. Understanding when this condition needs treatment helps parents make informed decisions about their child's care.
Common Symptoms of Pre-auricular Sinus
Pre-auricular sinus may not always cause symptoms and is often discovered during routine physical examinations in infancy or early childhood. Many children with this condition never experience any problems. However, when complications occur, symptoms may include the following:
Signs of Infection
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Recurrent infections with episodes of inflammation and pain occurring multiple times
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Redness and warmth around the sinus opening indicating active infection
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Swelling in the area in front of the ear
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Pain or tenderness when touching the area or during infection
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Discharge of white, yellow, or blood-tinged fluid or pus draining from the opening
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Unpleasant odor from the discharge
Abscess Formation
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Painful lump developing near the pre-auricular sinus
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Rapidly increasing swelling as pus accumulates
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Fever when infection becomes more severe
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Collection of pus that may require drainage
Associated Symptoms
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Enlarged lymph nodes around the ear and neck that become tender and swollen
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Difficulty sleeping on the affected side due to pain
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Visible opening that may occasionally release small amounts of discharge
If your child experiences recurrent infections or develops an abscess, evaluation for pre-auricular sinus removal may be necessary to prevent ongoing problems.
What Causes Pre-auricular Sinus?
The exact cause of pre-auricular sinus is not fully understood, but it is a condition that develops during fetal development.
Developmental Origin
Pre-auricular sinus forms during the early weeks of pregnancy when the structures of the face and ears are developing. The ear develops from six small bumps of tissue called hillocks that eventually fuse together to form the complete external ear. Pre-auricular sinus is believed to arise from incomplete fusion or closure of these structures during ear formation, leaving a small tract beneath the skin. This occurs between the 4th and 8th weeks of pregnancy.
Genetic Factors
Pre-auricular sinus often runs in families, suggesting a hereditary component. If one parent has a pre-auricular sinus, their children have an increased chance of having one as well.
The condition can be inherited in a dominant pattern, meaning only one parent needs to carry the trait for it to potentially appear in their children. The condition affects people of all ethnic backgrounds but appears to be more common in certain populations, particularly those of Asian and African descent.
Not Caused by External Factors
It is important for parents to understand that pre-auricular sinus is not caused by anything the mother did or didn't do during pregnancy. It's simply a variation in normal development that occurs early in fetal growth.
Consequences of Untreated Pre-auricular Sinus
While many pre-auricular sinuses have no symptoms throughout life, those that become problematic can lead to complications if not properly treated.
Recurrent Infections
The primary concern with pre-auricular sinus is the risk of repeated infections. The narrow tract can trap dead skin cells, bacteria, and other debris that cannot drain properly. This creates an ideal environment for bacterial growth, leading to recurrent infections that cause pain, swelling, and discharge.
Each infection episode requires antibiotics and causes discomfort for your child. Without complete sinus tract removal, infections typically recur even after successful antibiotic treatment.
Abscess Formation
When infection becomes severe, pus can accumulate within the sinus tract, forming an abscess. This painful collection of infection causes significant swelling and tenderness.
Abscesses require urgent drainage to relieve pain and prevent the infection from spreading. Repeated abscess formation can occur without definitive pre-auricular sinus excision.
Chronic Drainage
Some pre-auricular sinuses develop chronic drainage where small amounts of fluid or pus continuously leak from the opening. This can be bothersome, requiring frequent cleaning, and may cause skin irritation around the opening. The persistent moisture and odor can be socially distressing for children as well.
Scarring
Repeated infections and abscess drainage procedures can lead to scarring in the area in front of the ear. Multiple episodes of inflammation damage the tissue, resulting in more noticeable scars than would occur with a single, planned pre-auricular sinus removal procedure performed before complications develop.
Impact on Quality of Life
Children with recurrent infections may miss school, experience disrupted sleep, and feel self-conscious about the visible opening or drainage. The unpredictability of infection episodes causes anxiety for both children and parents. Pain during acute infections can interfere with normal activities and enjoyment of childhood.
Risk of Incomplete Treatment
If pre-auricular sinus excision is attempted during an active infection, the inflammation makes it more difficult to identify and remove the entire tract. Incomplete removal leads to recurrence, requiring additional surgery. This is why definitive pre-auricular sinus removal is best performed when there is no active infection.
How to Treat Pre-auricular Sinus in Children
Treatment for pre-auricular sinus depends on whether your child has symptoms and the frequency of infections. At The Little Surgery, Dr. Ong Lin Yin provides comprehensive evaluation and expert pre-auricular sinus excision when needed.
Observation for Asymptomatic Cases
If your child's pre-auricular sinus has never caused problems, treatment may not be necessary. Many children with this condition never experience infection and can simply live with the small opening.
We recommend monitoring for any signs of infection and maintaining good hygiene around the area. Parents should contact us if symptoms develop.
Treatment for Active Infection
When pre-auricular sinus becomes infected, initial treatment focuses on controlling the infection before considering surgery.
Antibiotics are prescribed to treat the bacterial infection causing inflammation and discharge. The specific antibiotic is chosen based on the likely bacteria involved. A full course of antibiotics must be completed even if symptoms improve quickly.
Warm compresses applied to the affected area several times daily can help reduce swelling and promote drainage of any accumulated pus. Pain management with appropriate pain relievers helps keep your child comfortable during the infection.
Incision and Drainage
If an abscess forms, immediate drainage is necessary to relieve pain and pressure. A small incision is made to allow the pus to drain out. The cavity is cleaned with a sterile solution.
This procedure provides quick relief but does not remove the underlying sinus tract, so recurrence is likely without definitive pre-auricular sinus removal later.
Ultrasound Pre-auricular Sinus Evaluation
Before performing pre-auricular sinus excision, we may use ultrasound pre-auricular sinus imaging to map the tract. Ultrasound helps visualize the path of the sinus tract beneath the skin, identify any branching or complex anatomy, determine the depth and extent of the tract, and plan the surgical approach for complete removal. This imaging ensures thorough complete sinus tract removal during surgery.
Pre-auricular Sinus Excision (Surgical Removal)
For children experiencing recurrent infections or complications, pre-auricular sinus removal is recommended. This definitive treatment involves surgical excision of the entire sinus tract to prevent future problems.
Pre-auricular sinus excision should ideally be performed when there is no active infection. Surgery during an acute infection is more challenging and has higher recurrence rates. We typically wait 4-6 weeks after an infection has resolved before performing pre-auricular sinus removal.
Pre-auricular sinus excision is performed under general anesthesia to ensure your child's comfort. An elliptical incision is made around the opening to completely remove the tract. We carefully trace and remove the entire sinus tract, which may extend several centimeters beneath the skin. Any infected or abnormal tissue surrounding the tract is also excised. The wound is closed with fine sutures designed to minimize scarring.
Your child can typically go home the same day. Pain is managed with appropriate medications. The area is kept clean and dry while healing. Sutures are removed after 5-7 days. Follow-up visits ensure proper healing and monitor for any signs of complications.
Why Choose The Little Surgery for Pre-auricular Sinus Treatment
The Little Surgery provides comprehensive care for pre-auricular sinus, from initial evaluation and infection management to expert pre-auricular sinus incision or excision with complete sinus tract removal.
Experienced Pediatric Surgeon
Dr. Ong Lin Yin brings over 20 years of experience in paediatric surgery, including management of both infected and asymptomatic pre-auricular sinuses. As the former Head of Department of Paediatric Surgery at KK Women's and Children's Hospital, she has successfully treated numerous cases from acute infections to pre-auricular sinus removal with excellent outcomes.
Comprehensive Care
We offer comprehensive treatment for all stages of pre-auricular sinus, including evaluation and diagnosis of the condition, management of acute infections with appropriate antibiotics, abscess drainage when needed for immediate relief, ultrasound pre-auricular sinus assessment to map the tract before surgery, and definitive pre-auricular sinus excision with complete sinus tract removal.
Whether your child needs urgent care for infection or planned surgery for recurrent problems, we provide expert treatment at every stage.
Family-centered Approach
We understand that parents may have questions about managing pre-auricular sinus, whether dealing with a first infection or considering surgery. Dr. Ong takes time to explain the condition and discuss all treatment options from conservative management to surgical intervention. As a mother herself, she provides compassionate care that supports the whole family.
Contact The Little Surgery Today
If your child has a pre-auricular sinus that is causing recurrent infections or other problems, we can help.
Contact The Little Surgery today and take the first step toward ensuring your child's health and happiness.