January2016

Have You Seen a Hole in Front of Your Ear?

ENT Manila, Philippines - pre-auricular sinusThis is a common congenital anomaly called a PRE-AURICULAR SINUS.

You see, when you were just a fetus in your mother’s wombs, you looked like a tadpole. And the external ear or the pinna, looked like gills.

These “gills” are called the Hillocks of His which are seen at around the 6th week of gestation. These Hillocks then fuse together to become our external ear.

An incomplete fusion of these Hillocks results in any ear deformity, including a PRE-AURICULAR SINUS.

Pre-auricular sinuses are frequently seen on routine physical examination by an ENT in Philippines as small holes in front of the external ear.

These holes are openings into a narrow tube or duct which connects into the perichondrium (or the thin cover) of the ear cartilage.

Most people with pre-auricular sinuses are asymptomatic. Only one third of persons are aware of their malformations.

However, some patients may have pus or foul-smelling discharge from the small opening. These draining sinuses are prone to become infected.

Infections of these pre-auricular sinuses present with swelling of the area anterior to the ear and ulcerations. Often, these ulcerations are treated with antibiotics and the pre-auricular sinus, which is the source of the infection, is neglected. When the infections are recurrent, the area becomes scarred and deformed.

[This is a picture of a 10 year old I operated on for a chronically infected pre-auricular sinus.]

Once a patient has infection of the sinus, antibiotics must be started. Other laboratory studies such as culture of the abscess may be done to make sure the pathogens are covered for by the given drugs.

Surgical removal of the sinus tract is advised once infection occurs because the risk of repeated infections is high.

Surgery involves COMPLETELY removing the opening and tracing the duct to the infected pouch, removing even part of the ear cartilage is advocated. Incomplete excision results in recurrence as high as 43 % in some studies.

It is important therefore, that you should consult a skilled head and neck surgeon for removal of your pre-auricular sinus.

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