A preauricular sinus is a common congenital malformation of the preauricular soft tissues. It is a sinus located near the front of the ear and is lined with squamous epithelium and thus may produce epithelial-lined subcutaneous cysts, which may become infected, leading to cellulitis or abscess. Patients may have other congenital anomalies such as hearing loss or renal disease. Patients may present with recurrent ear discharge, pain, swelling, redness, itching, headache, and fever. The diagnosis is often overlooked in early stages.
Management and Disposition
Initiate oral antibiotics to cover for S aureus (most common). Incision and drainage should be avoided in the emergency department (ED). Needle aspiration may be attempted and may give some relief. Discharge patients with antibiotics and instructions for using a warm compress and oral analgesics. Follow-up with an otolaryngologist for complete excision of the sinus track is indicated.
Preauricular sinus abscesses may be confused with 1st branchial cleft cysts.
Because of their close proximity to the facial nerve, referral to a specialist who is familiar with the underlying anatomy is recommended.
Preauricular Sinus Abscess. Recurrent preauricular swelling and redness in the area of a “pit” suggests sinus abscess and was confirmed on contrast-enhanced CT scan. (Photo contributor: Lawrence B. Stack, MD.)
Preauricular Sinus Abscess. Painful preauricular swelling and redness and a visible “pit” are seen. A loculated sinus abscess was confirmed on contrast-enhanced CT scan. Facial and periorbital edema were present. (Photo contributor: Kevin J. Knoop, MD, MS.)