Preauricular Sinus and Accessory Auricle

Unrelated abnormalities in the preauricular area were noted in a 50-year-old man who had presented with acute rhinosinusitis following an upper respiratory tract infection. The patient stated that he had had these deformities since birth.

The patient had both a preauricular sinus and an accessory auricle, which can be associated with genetic hearing loss. Dr Youn W. Park of Barberton, Ohio, reports that occasionally one of these congenital abnormalities occurs; the concurrence of both defects in a single patient is unusual.

Preauricular sinus, also called preauricular cyst or fistula, and accessory auricle, or accessory lobule or hillock, result from the faulty fusion of the hillocks of the first and second branchial arches, the hillocks of His.

An odorous discharge may occur. Infection of the sinus can produce swelling, fever, pain, and tenderness in some patients. Unless infections recur, surgical treatment of the sinus is not required. Incomplete excision of the sinus may lead to recurrent infection and require more difficult revision surgery. Dr Park writes that this patient's sinus became infected very rarely; therefore, surgery was not warranted.

Accessory auricles that present as preauricular or, rarely, postauricular skin tags may contain cartilage. They can be excised for cosmetic reasons.