I’ve always had a tiny hole in my head – people think it’s a piercing | Science | News

The pit is located on my right ear, it is genetic and my elder sister has one too (Image: Zasha Whiteway-Wilkinson)

I’ve always had a small hole on the side of my head, but people often don’t believe that I was born with it. To shock my friends when I was younger, I’d stick a piercing in it to prove it wasn’t self-inflicted.

These are known as preauricular pits or pilonidal sinus. Apart from my sister, I’ve never met anyone else with one.

However, Medical News Today reports that preauricular pits are a ‘common birth irregularity first reported in 1864.

I have just one, but some people can have more. It’s so tiny that you wouldn’t notice it unless I pointed it out.

In the photos in this article, you can see mine located on the ridge above the ear canal near the cheek. If you didn’t know what you were looking at, it could be mistaken for a piercing or beauty spot.

The effects of these pits vary widely among individuals, but generally, they’re harmless and not something to worry about. However, the pit can indicate a much more serious condition.

So, what exactly is a ‘preauricular pit’, and how common are they?

The side profile of a person’s face – the ear shows a preauricular pit (Image: Zasha Whiteway-Wilkinson)

Healthcare professionals usually spot these pits during routine check-ups of newborns. They can appear on one or both ears, and there may be more than one present, reports Gloucestershire Live.

However, it’s more common to find a pit in just one ear.

The hole is linked to a sinus tract that shouldn’t exist, running beneath the skin with a path that can be either short or complex. Preauricular pits are different from preauricular tags, which are harmless skin lumps.

In 2019, research by the American Academy of Family Physicians (AAFP) revealed that preauricular skin lesions, including pits and tags, affect between five and 10 babies per 1,000 live births.

Generally, these holes are minor abnormalities that don’t lead to severe complications. However, some individuals may develop an infection in the pit and the sinus tract.

Occasionally, an abscess might form at the pit site. Recurrent infections may necessitate surgery.

In rare instances, a preauricular pit may be a symptom of another condition, such as Beckwith-Wiedemann syndrome or branchio-oto-renal syndrome. Beckwith-Wiedemann syndrome is an overgrowth syndrome affecting various body parts.

Branchio-oto-renal syndrome is a genetic disorder causing tissue anomalies in the ears, neck, and kidneys. Other names include preauricular fissure and preauricular sinus.

Why do some people have them?

The side profile of a person’s face – the ear shows a preauricular pit (Image: Zasha Whiteway-Wilkinson)

Preauricular pits form during development in the womb. They likely result from imperfect fusion of the auricle, the visible part of the ear.

The auricle forms during the sixth week of gestation. The pits may be inherited, meaning they can run in families.

The condition can also occur sporadically and for unknown reasons. If it affects both ears, it’s more likely to be a genetic irregularity.

According to the AAFP, up to one per cent of babies have preauricular skin lesions, although the incidence varies. In some parts of Africa, the rate is as high as 10 per cent.

What are the risks and should I see a doctor?

Preauricular pits typically don’t cause serious issues. The main risk is infection and cyst development, which can lead to:

  • Fever;
  • Fluid drainage from the hole;
  • Pain;
  • Redness;
  • Swelling;
  • An abscess may form in an infected preauricular pit. An abscess is a small, painful lump that contains pus.

A study on young adult men with preauricular pits found that about 25 per cent developed symptoms by adulthood, with recurrent sinus discharge being the most common.

Individuals with one or more preauricular pits will likely need to consult an otolaryngologist, also known as an ear, nose, and throat specialist. These doctors specialise in conditions like preauricular pits.

Unless an infection develops, a preauricular pit usually doesn’t require treatment. However, anyone experiencing symptoms of infection should seek medical attention immediately.

Given the proximity of this infection to the brain, prompt medical intervention is crucial to prevent complications. Typically, antibiotic treatment is necessary to clear the infection.

If an abscess forms and is resistant to antibiotics, a doctor may need to perform a needle aspiration to drain the pus. The bacteria in the pus may also be examined to see if other antibiotics would be more effective.

Should a needle aspiration prove unsuccessful, an incision may need to be made in the abscess to drain it.

Repeated infections might necessitate the surgical removal of the pit and the connecting sinus tract. This type of surgery requires general anaesthesia and takes place in an outpatient facility, lasting up to an hour.

Post-surgery, the doctor will provide guidance on managing pain, preventing infection, and other aftercare aspects.

Full recovery can take several weeks. The surgeon will typically wait until the site is free from infection and swelling before performing the procedure.

In summery, a preauricular pit, or a hole in front of the upper ear, is a fairly common birth abnormality. In rare cases, it could indicate the presence of a syndrome.

However, most instances are not a cause for concern. Individuals with one or more preauricular pits are generally healthy otherwise.

Unless an infection develops, treatment or removal of a preauricular pit is not necessary. If an infection does occur, immediate antibiotic treatment is required.

Persistent infections may necessitate the surgical removal of the pit and connecting tract.

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