Pre-auricular Sinuses & Tags

Both conditions arise from the way the outer ear forms before birth, from several small buds of tissue that fuse together.

A pre-auricular skin tag is a small, soft nub of skin, sometimes containing a little cartilage, sitting just in front of the ear. It is harmless and causes no symptoms.

A pre-auricular sinus is a tiny pit or opening in the skin just in front of the upper ear. It leads to a narrow tract beneath the skin, which can collect debris and become infected, producing swelling, pain and discharge. Both may occur on one or both sides and are sometimes seen in other family members.

Skin tags are removed mainly for cosmetic reasons, or if they are being caught on clothing or glasses. There is no urgency and the timing is chosen to suit your family.

A pre-auricular sinus that has never caused trouble may simply be left alone. However, once a sinus has become infected it tends to do so again, and each infection makes the tract harder to remove cleanly. Removal is therefore recommended after a first infection has settled. Your child's surgeon may arrange a hearing test or kidney ultrasound in some children, as these ear features can occasionally be linked with other conditions.

Both procedures are performed under a general anaesthetic as day surgery, with local anaesthetic added to reduce discomfort on waking.

A skin tag is removed through a small incision at its base, and any cartilage within it is trimmed so that the skin lies flat. A sinus is more involved: the opening and the entire underlying tract are carefully traced and removed as one piece, since leaving any behind can allow it to re-form. The tract often runs close to the cartilage of the ear. The skin is closed with fine dissolving stitches and skin glue or a small dressing is applied.

Most children need only simple pain relief for a day or two. Keep the area clean and dry for the first couple of days, then washing is fine, taking care to pat the area gently.

Some swelling and bruising in front of the ear is normal and settles within a week or two. The scar sits in the natural fold in front of the ear and fades over the following months. Contact the team if there is increasing redness, discharge or fever. A follow-up appointment will be arranged to check the wound.