Preauricular Sinus Infections: When to Seek ENT Care

Preauricular sinus issues?

Hello Doctor, my son was born with a small pit in his right ear, which is an auricular sinus, and it has been fine until now.
The first infection occurred when he was one and a half years old, when he contracted an adenovirus, and I later noticed swelling in front of the ear.
We visited a pediatrician who only prescribed topical medication and anti-inflammatory drugs, but they were ineffective.
It wasn't until we went to an otolaryngologist and received antibiotics that the swelling subsided.
Now, three months later, I suspect it is starting to swell again.
I would like to ask the doctor: 1.
Does inflammation of the auricular sinus require antibiotics for improvement, and should I be seeing an otolaryngologist instead of a pediatrician? 2.
Under what frequency of occurrences would surgery be recommended? Thank you, Doctor.

Wendy T, 30~39 year old female. Ask Date: 2024/07/02

Dr. Zheng Jueyi reply Otolaryngology

Hello, 1.
If the preauricular sinus is inflamed due to a bacterial infection, such as noticeable redness, swelling, heat, and pain, antibiotics are necessary for improvement.
You can visit either an otolaryngologist or a pediatrician.
2.
If there is severe cellulitis or recurrent abscesses, or if frequent episodes of redness and inflammation significantly affect daily life, surgical intervention should be considered.

Reply Date: 2024/07/02

More Info

Preauricular sinus infections can be a source of concern, especially when they recur or become symptomatic. A preauricular sinus, also known as a preauricular pit, is a congenital malformation that appears as a small hole or dimple located in front of the ear. While many individuals with this condition may never experience any issues, infections can occur, particularly if bacteria enter the sinus.

1. Do Preauricular Sinus Infections Require Antibiotics?
When a preauricular sinus becomes infected, it often presents with symptoms such as redness, swelling, and pain in the area surrounding the sinus. In your son's case, it sounds like he experienced an infection that required antibiotic treatment to resolve. Antibiotics are typically prescribed when there is a clear indication of bacterial infection, especially if there is significant swelling or pus formation. The initial treatment by the pediatrician may not have been sufficient if the infection was more severe or if it was not specifically targeting the bacteria involved.
Seeing an ENT specialist is advisable in cases of recurrent infections, as they have more specialized knowledge regarding ear, nose, and throat conditions. An ENT can provide a more thorough evaluation and may be able to prescribe a more effective antibiotic or suggest other treatment options.

2. When to Consider Surgery?
The decision to consider surgical intervention for a preauricular sinus typically depends on the frequency and severity of infections. If your son experiences multiple infections within a year, or if the infections are particularly severe, surgery may be recommended. The surgical procedure, known as excision of the preauricular sinus, involves removing the sinus tract to prevent future infections.
Generally, if a child has two or more infections in a year, or if the infections are recurrent and cause significant discomfort or complications, an ENT specialist may suggest surgical intervention. The goal of surgery is to eliminate the source of recurrent infections and improve the child's quality of life.

In summary, if your son is showing signs of another infection in the preauricular sinus, it would be prudent to consult with an ENT specialist. They can assess the situation and determine whether antibiotics are necessary or if surgical options should be considered. Early intervention can help prevent complications and ensure that your son remains healthy.
It’s also important to monitor any changes in symptoms closely. If you notice increased swelling, fever, or drainage from the sinus, seeking immediate medical attention is advisable. Keeping a record of the frequency and severity of infections can also be helpful when discussing treatment options with the healthcare provider.

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