PREAURICULAR SINUS IN CHILDREN
WHAT IS A PREAURICULAR SINUS?
A preauricular sinus is a congenital malformation which occurs then the ear tissues did not fuse completely during the 6th week of pregnancy. It appears as a pinpoint hole in front of the external ear. What is not seen is that it has a tiny tunnel underlying, which may accumulate dirt and sebum. It exists in about 1% of the general population. It may be hereditary.
You should bring your child to a doctor if he experiences any of these symptoms
- Redness of the skin area around the sinus
- Painful lump
- Foul smelling discharge from the sinus opening
Do note that other skin infections may occur anywhere around the sinus opening and may or may not involve the sinus opening itself.
WHAT DOES TREATMENT INVOLVE?
Your doctor will assess the severity of any infection and may prescribe oral antibiotics, intravenous antibiotics or surgery to release any collection of pus under the skin.
A surgery to remove the entire sinus (both the hole and the underling tunnel/ cyst) may be planned at a later date to prevent future infections.
Surgery for the non-infected preauricular sinus is not recommended unless there is persistent discharge from the sinus opening.
WHAT DOES THE PREAURICULAR SINUS SURGERY INVOLVE?
The operation is a day surgery procedure which is done under general anesthesia (GA). An oval-shaped cut around the sinus opening is made and the whole sinus tract (including a small cuff of the underlying ear cartilage attached to its end) is removed.
WHAT THE RISKS INVOLVED IN THE SURGERY?
An anesthetist will see your child before surgery and advise you on the risks of GA.
Some risks specific to the surgery include:
- Wound bleeding and infection (less than 1%)
In some cases, a course of oral antibiotics is given post-operation to help prevent infection. If the wound is infected your child may require regular daily dressings until complete healing occurs.
While the underlying tissue is healing, there is a potential for fluid to accumulate in the wound, leading to the formation of a seroma. Small seromas usually resolve spontaneously with post-operative wound care, oral antibiotics and pressure dressing.
- Recurrence of infection
Even though every attempt is made to remove the preauricular tract completely, there is still a possibility of the infection recurring (less than 2%). This risk is higher if your child has had many infective episodes before surgery, or if surgical removal is attempted during an active infection.
- Wound dehiscence/ poor wound healing
Sometimes the wound may fail to heal completely, or it may split open after initial closure. As a result, your child will need daily dressing and wound care for over a week until the wound heals.
CARING FOR YOUR WOUND AFTER SURGERY
Keep the pressure dressing dry for 48 hours after the surgery
Avoid all strenuous physical activities for one week
Consult a doctor if your child experiences the following:
- Increasing swelling and pain around the wound
- Excessive bleeding or discharge from the wound site/ dressing
- Persistent high fever above 38 degrees Celsius, despite anti-fever medications
A follow-up appointment is scheduled one week after discharge to check for wound healing. There is no need for removal of stitches as soluble sutures will be used.
Senior Ear, Nose & Throat Consultant
Nobel ENT Centre (Mount Alvernia)
Dr Annette Ang is a Senior Ear, Nose and Throat Consultant who has spent the last decade practising as a senior consultant pediatric otolaryngologist at Singapore’s top pediatric hospital. She has a special interest in complex airway management.
She brings with her a wealth of surgical experience in managing children with ear, nose, throat and airway problems.
To book an appointment,