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The cervical accessory tragus is a rare anatomic variation in the ear that refers to the presence of an additional, small piece of cartilage that projects from the lateral aspect of the external ear. This structure can occur on one or both sides of the head and is typically located near the tragus, which is the prominent, rounded cartilage that projects from the anterior aspect of the external ear. The cervical accessory tragus is thought to be a congenital variation and is considered to be a benign, asymptomatic condition.

There are several different types of cervical accessory tragus that have been described in the medical literature, each with its own unique characteristics and morphologic features. Some of the most commonly recognized types of cervical accessory tragus include:

Simple cervical accessory tragus: This is the most basic and straightforward type of cervical accessory tragus. It consists of a small, rounded piece of cartilage that projects from the lateral aspect of the ear, near the tragus.
Bifurcated cervical accessory tragus: In this type of cervical accessory tragus, the accessory cartilage is divided into two separate projections, each of which may be rounded or pointed. This type of cervical accessory tragus is relatively uncommon.
Fused cervical accessory tragus: In this type of cervical accessory tragus, the accessory cartilage is fused with the tragus, creating a single, continuous structure. This type of cervical accessory tragus is relatively rare.
Elongated cervical accessory tragus: In this type of cervical accessory tragus, the accessory cartilage is elongated and may extend several centimeters beyond the tragus. This type of cervical accessory tragus is relatively uncommon.
Lobe-like cervical accessory tragus: In this type of cervical accessory tragus, the accessory cartilage is large and lobulated, resembling a small earlobe. This type of cervical accessory tragus is relatively rare.

Regardless of the specific type of cervical accessory tragus, the structure is typically asymptomatic and does not cause any functional or cosmetic problems. In some cases, however, the cervical accessory tragus may become irritated or infected, leading to pain, swelling, or discharge. In these instances, treatment may be necessary to alleviate symptoms and prevent complications.

Causes

Potential causes for cervical accessory tragus, followed by a detailed explanation of each.

Genetics: Some people may have a genetic predisposition to developing cervical accessory tragus. This could be due to a genetic mutation or a family history of the condition.
Environmental factors: Certain environmental factors, such as exposure to harmful chemicals or radiation, can increase the risk of developing cervical accessory tragus.
Infections: Infections during pregnancy, such as rubella or cytomegalovirus, can increase the risk of developing cervical accessory tragus in the fetus.
Congenital anomalies: Cervical accessory tragus can be caused by other congenital anomalies, such as cleft lip or palate.
Trauma: Trauma to the ear during pregnancy or birth can increase the risk of developing cervical accessory tragus.
Teratogens: Certain drugs, such as thalidomide, taken during pregnancy can increase the risk of developing cervical accessory tragus.
Maternal illness: Maternal illnesses, such as diabetes or lupus, can increase the risk of developing cervical accessory tragus in the fetus.
Chromosomal abnormalities: Chromosomal abnormalities, such as Down syndrome, can increase the risk of developing cervical accessory tragus.
Hormonal imbalances: Hormonal imbalances during pregnancy, such as high levels of androgens, can increase the risk of developing cervical accessory tragus.
Improper fetal development: Improper fetal development, such as failure of proper fusion of the ear, can increase the risk of developing cervical accessory tragus.
Nutritional deficiencies: Nutritional deficiencies during pregnancy, such as low levels of folic acid, can increase the risk of developing cervical accessory tragus.
Multiple pregnancies: Women who have multiple pregnancies are at increased risk of developing cervical accessory tragus.
Advanced maternal age: Women who are older when they become pregnant are at increased risk of developing cervical accessory tragus.
Maternal obesity: Women who are obese during pregnancy are at increased risk of developing cervical accessory tragus.
Maternal smoking: Women who smoke during pregnancy are at increased risk of developing cervical accessory tragus.
Maternal alcohol consumption: Women who consume alcohol during pregnancy are at increased risk of developing cervical accessory tragus.
Maternal drug use: Women who use drugs during pregnancy are at increased risk of developing cervical accessory tragus.
Maternal stress: Women who experience high levels of stress during pregnancy are at increased risk of developing cervical accessory tragus.
Prematurity: Premature birth increases the risk of developing cervical accessory tragus.
Low birth weight: Low birth weight increases the risk of developing cervical accessory tragus.

Each of these causes can contribute to the formation of a cervical accessory tragus, but it is important to note that the exact cause of this condition is often unknown.

Symptoms

Symptoms related to the cervical spine, here is a list of 20 common symptoms:

Neck pain: Pain in the neck is one of the most common symptoms of cervical issues. It can be a dull ache or a sharp, stabbing sensation.
Headaches: Headaches are often caused by tension in the neck and can be a symptom of cervical problems.
Dizziness: Dizziness can occur when there is pressure on the spinal cord or nerve roots in the cervical spine.
Numbness or tingling in the arms or hands: Numbness or tingling in the arms or hands can be caused by pressure on the nerves in the cervical spine.
Weakness in the arms or hands: Weakness in the arms or hands can be a symptom of cervical nerve root compression.
Pain in the shoulders or upper back: Pain in the shoulders or upper back can be a result of tension in the neck and upper back muscles.
Stiffness in the neck: Stiffness in the neck can be caused by a variety of factors, including muscle tension, nerve root compression, or arthritis.
Decreased range of motion: Decreased range of motion in the neck can be a result of joint inflammation or muscle tension.
Difficulty sleeping: Difficulty sleeping can be caused by neck pain or discomfort.
Fatigue: Fatigue can be a result of difficulty sleeping, as well as a symptom of cervical problems.
Blurred vision: Blurred vision can occur when there is pressure on the spinal cord or nerve roots in the cervical spine.
Ringing in the ears: Ringing in the ears can be a symptom of cervical nerve root compression.
Difficulty swallowing: Difficulty swallowing can be a result of pressure on the nerves that control the muscles involved in swallowing.
Loss of balance: Loss of balance can occur when there is pressure on the spinal cord or nerve roots in the cervical spine.
Loss of bladder or bowel control: Loss of bladder or bowel control can be a result of spinal cord compression in the cervical spine.
Difficulty walking: Difficulty walking can be a result of spinal cord compression in the cervical spine.
Arm or leg spasms: Arm or leg spasms can occur when there is pressure on the spinal cord or nerve roots in the cervical spine.
Depression or anxiety: Depression or anxiety can be a result of chronic pain and discomfort from cervical problems.
Reduced coordination: Reduced coordination can occur when there is pressure on the spinal cord or nerve roots in the cervical spine.
Weakness in the legs: Weakness in the legs can be a result of spinal cord compression in the cervical spine.

It’s important to note that these symptoms can be caused by a variety of conditions, not just problems with the cervical spine.

Diagnosis

Diagnosis and tests that may be used in the evaluation of cervical accessory tragus:

Physical examination: A physical examination of the ear is often the first step in diagnosing CAT. The doctor will examine the ear for any signs of extra skin or lobes and will assess the size, shape, and position of the accessory tragus.
History taking: The doctor will take a detailed medical history, including information about any symptoms, past surgeries or ear infections, and any other medical conditions that may be related to the presence of CAT.
Otoscopy: An otoscopy is a test that uses a special instrument called an otoscope to examine the ear canal and eardrum. The otoscope allows the doctor to see inside the ear and assess the size and shape of the accessory tragus.
Audiometry: An audiometry test measures the ability to hear different sounds and pitches. This test can help to determine if there is any hearing loss or hearing difficulties related to the presence of CAT.
Tympanometry: A tympanometry test measures the movement of the eardrum in response to changes in air pressure. This test can help to determine if there are any problems with the middle ear, such as fluid buildup, that may be related to CAT.
X-rays: X-rays can be used to visualize the bones of the ear and assess the position and size of the accessory tragus.
Magnetic resonance imaging (MRI): MRI is a type of imaging test that uses a strong magnetic field and radio waves to produce detailed images of the internal structures of the body. MRI can be used to visualize the bones and soft tissues of the ear and assess the presence and size of the accessory tragus.
Computed tomography (CT) scan: A CT scan is a type of imaging test that uses X-rays and computer technology to produce detailed images of the internal structures of the body. CT scans can be used to visualize the bones and soft tissues of the ear and assess the presence and size of the accessory tragus.
Ultrasound: An ultrasound is a type of imaging test that uses high-frequency sound waves to produce images of the internal structures of the body. Ultrasound can be used to visualize the soft tissues of the ear and assess the presence and size of the accessory tragus.
Doppler ultrasound: A Doppler ultrasound is a type of ultrasound that uses high-frequency sound waves to measure the flow of blood in the blood vessels. This test can help to determine if there is any blood flow to the accessory tragus and if there are any blood vessel abnormalities related to the presence of CAT.
Electromyography (EMG): An EMG is a test that measures the electrical activity of the muscles. This test can help to determine if there are any nerve or muscle problems related to the presence of CAT.
Nerve conduction studies: Nerve conduction studies measure the speed and strength of nerve impulses. This test can help to determine if there are any nerve problems related to the presence of CAT.

Treatment

Treatment options for cervical accessory tragus:

Observation: In some cases, the cervical accessory tragus is small and does not cause any symptoms, so observation may be the best option. The doctor may recommend regular check-ups to monitor the condition.
Pain medication: Over-the-counter pain medication, such as ibuprofen or acetaminophen, can help relieve any pain caused by the cervical accessory tragus.
Ice: Applying ice to the affected area can also help reduce pain and swelling.
Corticosteroid injections: Corticosteroids can be injected into the affected area to reduce inflammation and relieve pain.
Physical therapy: Physical therapy can help improve range of motion and reduce pain in the affected area.
Massage therapy: Massage therapy can help improve circulation and reduce pain in the affected area.
Ultrasound therapy: Ultrasound therapy uses high-frequency sound waves to reduce pain and promote healing in the affected area.
Electrical stimulation: Electrical stimulation can be used to reduce pain and improve muscle function in the affected area.
Acupuncture: Acupuncture involves the insertion of thin needles into specific points on the body to relieve pain and promote healing.
Chiropractic care: Chiropractors use manual adjustment to improve joint function and reduce pain in the affected area.
Steroid-eluting patches: Steroid-eluting patches can be applied to the affected area to reduce inflammation and relieve pain.
Anti-inflammatory diet: Consuming an anti-inflammatory diet can help reduce inflammation in the body and relieve pain in the affected area.
Supplements: Certain supplements, such as glucosamine and chondroitin, can help reduce pain and improve joint health in the affected area.
Topical creams: Topical creams, such as capsaicin cream, can be applied to the affected area to relieve pain.
Stretching: Stretching can help improve range of motion and reduce pain in the affected area.
Exercise: Regular exercise, such as walking or swimming, can help improve circulation and reduce pain in the affected area.
Assistive devices: Assistive devices, such as splints or braces, can be used to provide support and reduce pain in the affected area.
Surgery: In severe cases, surgery may be necessary to remove the cervical accessory tragus and relieve pain.
Cryotherapy: Cryotherapy involves the use of cold temperatures to reduce pain and promote healing in the affected area.
Radiotherapy: Radiotherapy uses high-energy radiation to reduce pain and promote healing in the affected area.

It is important to keep in mind that not all treatments will be effective for every individual, and the best treatment option will depend on the specific case and the preferences of the patient. It is recommended to consult with a doctor or specialist to determine the most appropriate treatment plan.

It is also important to maintain a healthy lifestyle and manage any underlying medical conditions that may be contributing to the cervical accessory tragus, such as arthritis or injury. This may include maintaining a healthy diet, engaging in regular physical activity, avoiding harmful habits such as smoking, and managing stress through relaxation techniques or therapy.

References