Abstract
Background: Neonatal preauricular pit/sinus is a benign embryologic remnant of the first or second branchial arches. The estimated incidence in the US is 1 to 9/1000 newborns, higher in East Asian babies. Most remain asymptomatic throughout life. Inflammatory complications include discharge of squamous debris, cellulitis, or frank abscess. The purpose of this study was to survey pediatric otolaryngologists in the United States and Canada about management strategies for asymptomatic and symptomatic preauricular pits/sinuses. Study Design: A 15-item structured questionnaire covering questions on demographics, professional experience, and medical and surgical management of congenital preauricular pits/sinuses were sent by e-mail and selectively by regular mail to 273 members of the American Society of Pediatric Otolaryngology. Results: 175 of 273 responses (64%) were evaluable. 85% of respondents would simply observe cases of asymptomatic preauricular pit/sinus. Regarding further evaluation, 122 respondents (70%) would not recommend anything other than routine neonatal hearing screen, without need for repeat hearing tests in the first two years of life; 34 (19%) would also get BAER hearing test and a renal ultrasound. If a sinus drains sebaceous material intermittently, 65% of the surveyed pediatric otolaryngologists would recommend excision. Ninety nine percent of pediatric ENT respondents would excise a recurrently infected preauricular sinus. Conclusion: Watchful waiting, without requirement of periodic hearing tests in the first 24 months of life is certainly acceptable for management of neonatal asymptomatic preauricular pit/sinus. There is universal agreement that recurrently infected preauricular sinuses should be referred to a pediatric otolaryngologist for surgical excision of the fistulous tract.
Highlights
Neonatal preauricular pit/sinus is a benign embryologic remnant of the first or second branchial arches
The sinus tract can extend a median of 15 mm up to a maximum of several centimeters into the facial soft tissue
A 15-item structured questionnaire covering questions on demographics, professional experience, agreement with Virginia hearing screening policy, opinions regarding screening tests, referrals, medical and surgical management were sent to 273 members of the American Society of Pediatric Otolaryngology, for whom contact information was available
Summary
Neonatal preauricular pit/sinus ( termed preauricular cyst) is a benign embryologic remnant of the first or second branchial arches. Preauricular sinus usually have an associated straight or branching sinus tract (not a true fistula), lined by squamous epithelium. Neonatal preauricular pit/sinus is a benign embryologic remnant of the first or second branchial arches. The purpose of this study was to survey pediatric otolaryngologists in the United States and Canada about management strategies for asymptomatic and symptomatic preauricular pits/sinuses. Ninety nine percent of pediatric ENT respondents would excise a recurrently infected preauricular sinus. Conclusion: Watchful waiting, without requirement of periodic hearing tests in the first 24 months of life is certainly acceptable for management of neonatal asymptomatic preauricular pit/sinus. There is universal agreement that recurrently infected preauricular sinuses should be referred to a pediatric otolaryngologist for surgical excision of the fistulous tract
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