A preauricular sinus is a small hole or pit present from birth, usually found just at the front of the ear. It is a short sinus tract under the skin that forms when parts of the outer ear do not fuse completely during early development. They are congenital anomalies of the external ear arising from incomplete fusion of the first branchial arch in the sixth week of ear development. Genetic factors, associated syndromes and renal anomalies may contribute.Â
A preauricular sinus may be called a preauricular pit, ear pit, congenital preauricular fistula or preauricular cyst when a closed pocket is present. The sinus tract can trap dead skin cells, oil, other debris and bacteria. When this happens, it may become inflamed or infected. The condition is usually benign.Â
Recurrent infection can affect comfort and appearance. It may affect one or both ears and is more common in Asian populations than in some Western populations. In Singapore, parents often notice it during childhood, but adults may first seek help only after painful swelling or repeated discharge, though many live with a preauricular sinus without pain or discharge.
Barrie Tan ENT Head & Neck Surgery provides comprehensive care for preauricular sinus.
If you believe you or a loved one has preauricular sinus, contact us today.
You should see an ear, nose and throat (ENT) specialist if the pit becomes painful, swollen, red, leaky or repeatedly infected. A single mild irritation may settle with simple care, but a preauricular sinus infection should be assessed promptly, as antibiotics or drainage may be needed.
You should also arrange an ENT review if there is a recurrent discharge, a foul odour, a growing lump, scarring from previous infections, or symptoms that return after treatment. Children should be reviewed promptly if they develop a fever, increasing swelling, worsening pain or difficulty sleeping.
An ENT review is also important if there are associated concerns, such as hearing loss, an unusual ear shape, neck pits, second-branchial arch anomalies, a family history of kidney problems, or preauricular sinuses bilaterally. Most preauricular sinuses are isolated, but a small number can occur with inherited conditions or other congenital anomalies affecting the ears and kidneys.
Preauricular sinus diagnosis is usually made by examining the small opening and the surrounding skin. Dr Barrie Tan of Barrie Tan ENT Head & Neck Surgery will ask when the pit was first noticed, whether it has drained before, how often infections occur, and what treatment has already been tried.
The classic signs may vary from an asymptomatic pit to infected preauricular sinuses with discharge. The ear, face, neck and hearing may also be checked. If there is a discharge, a swab may guide antibiotics. Imaging is not needed for every patient. Ultrasound, CT, or MRI scans may be considered when the swelling is unusual, the infection is extensive, previous surgery has failed, or the tract is deeper or more complex.
The diagnosis also involves ruling out other causes of swelling near the ear, such as a skin cyst, an infected lymph node, a parotid gland problem, or a branchial cleft abnormality.
Treatment of the preauricular sinus depends on whether the pit is quiet, inflamed or infected. If there has never been an infection, treatment may simply involve keeping the area clean, avoiding trauma, and not squeezing or probing the opening.
During infection, treatment usually starts with oral antibiotics, pain relief and local wound care. Warm compresses may ease discomfort, but forceful squeezing should be avoided. If an abscess forms, antibiotics alone may not clear the trapped pus. The abscess may need incision and drainage, which means making a small incision to release the infected fluid.
Non-surgical care can settle the acute infection, but it does not remove the underlying tract. This is why infections may recur. Surgery to remove the preauricular sinus is generally planned after the infection has improved and the swelling has settled, unless urgent drainage is needed.
Excision of the preauricular sinus is the definitive treatment for recurrent infections, persistent discharge or a troublesome cyst formation. The operation removes the pit, sinus tract, any branches and associated cysts under the skin. Complete removal is important because recurrence most often results from leaving a portion of the tract behind.
This surgical procedure is a low-risk surgical intervention. Surgery is usually performed as a day procedure under local or general anaesthesia. A small incision is made around the pit. The surgeon carefully follows the entire sinus tract and removes it completely, sometimes with a small cuff of surrounding tissue or cartilage attachment near the ear. This reduces the chance that hidden branches are left behind.
For patients with recurrent infections or prior drainage, the tissue may be scarred, making the operation more complex.
Dr Barrie Tan was the former Head of the Department of Otolaryngology (ENT) at Singapore General Hospital and has dedicated his career to improving his patients’ ENT health and quality of life.
Recovery after preauricular sinus surgery is usually straightforward, but careful wound care lowers the risk of infection and recurrence. Preauricular sinus infection recovery time varies. A mild infection may improve within several days of appropriate antibiotics. An abscess or recurrent infection may take longer to resolve, especially if drainage is needed.
Risks include bleeding, infection, scarring, wound breakdown, persistent numbness and recurrences. The risk of recurrence is higher when surgery is performed during an active infection or when the tract is branched and difficult to fully remove.
The wound is usually covered with a dressing. Mild pain, swelling, bruising or tightness around the incision is expected for a few days. Patients are advised to keep the area dry for the recommended period, avoid scratching, complete any prescribed antibiotics, and attend follow-ups so the wound can be checked. Some patients notice a temporary numbness or altered sensation near the scar.
This surgery is usually completed within one hour, and patients are discharged the same day. Recovery from preauricular sinus surgery takes several weeks, and most patients return to normal activities within two weeks.
Barrie Tan ENT Head & Neck Surgery, can help by confirming the diagnosis, controlling infection, and planning treatment to reduce recurrence. Dr Barrie Tan offers comprehensive ear, nose, and throat care, including preauricular sinus surgery and related paediatric otorhinolaryngology procedures.
For preauricular sinus treatment in Singapore, Dr Barrie Tan provides ENT care at Gleneagles Hospital for children and adults with ear pits, recurrent discharge, abscesses and previous failed treatments.
If you or your child has a preauricular sinus that is painful, draining or repeatedly infected, contact Barrie Tan ENT for a consultation. Early assessment can relieve symptoms, prevent further abscesses and help you decide whether observation, medication or surgery is the right next step.
MBBS, MRCS (Edinburgh), MMed (Otorhinolaryngology), FAMS
Dr Barrie Tan is an ENT specialist at Gleneagles Hospital, Singapore, with more than 20 years of clinical and surgical experience. He previously served as Head of ENT and Director of the Centre for Hearing and Ear Implants at Singapore General Hospital. The information provided is not intended as medical advice. More about our medical experts.
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