The Medical Consumer's Advocate

Where DID you get that hole?

Q: I am just curious as to what these little holes are next to both of my ears. They appear to be deep in nature as I can't see the end near the surface. Could you help me out? I would really appreciate it.

A: This is known in the biz as a "preauricular pit." For the sake of orientation, here's a bit of anatomy: the outer rim of the ear is called the helix. The area where the helix is attached to the face is known as the helical root. A preauricular pit is a tiny (1 to 2 millimeter) hole in the skin of the helical root.

Pits are present at birth; they form during early fetal development. In the 5^th to 6^th week post-conception, 6 tiny lumps of tissue begin merging, and by the 20^th fetal week, these lumps have formed the external ear. If this process is something less than perfect, any number of external ear anomalies may result. Preauricular pits are (arguably) one of the milder anomalies that may result from imperfect external ear development. They are skin-lined and are typically less than one inch in depth.

Pits are significant for two reasons. First, pits can become infected. An infected pit usually presents as a soft or hard swelling at the helical root; press on the swollen area, and a drop of pus will emerge from the pit. This can be treated with antibiotics, of course, but if the pit keeps getting infected you would probably want to have it surgically removed. This can be done under local anesthesia. You must make sure that your surgeon is familiar with pits. Simply excising the outer (visible) portion of the pit is inadequate; the surgeon must excise the entire pit. An ear, nose and throat surgeon would be the best choice for this procedure, since we all have experience with pits.

Pits are also significant because they can be an indicator for other ear problems. In other words, there is a higher-than-chance association of pits with other (less visible) ear anomalies. These "deeper" anomalies are important because they usually impair hearing to some degree. You may or may not have noticed such a hearing loss; the loss may be mild, and may easily have gone unnoticed on school audiograms.

 

 

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