A preauricular cyst, also known as a preauricular sinus or tag, is a congenital (present at birth) fluid-filled sac that develops in front of the ear, near the cheekbone. Preauricular cysts are relatively common, occurring in about 1 in every 6,000 to 10,000 people. They are usually benign (non-cancerous) and do not cause any symptoms, but in some cases, they can become infected or develop into a painful mass. In this article, we will discuss the definition, types, and details of preauricular cysts.
Definition: A preauricular cyst is a small sac or pocket that forms in the soft tissue in front of the ear. The cyst is usually filled with fluid and is surrounded by a thin wall of tissue. Preauricular cysts are usually small, measuring only a few millimeters in diameter, but they can grow larger over time. They are usually asymptomatic (not causing any symptoms), but in some cases, they can become infected or cause pain and discomfort.
Types of Preauricular Cysts: There are several different types of preauricular cysts, each with its own unique characteristics. Some of the most common types of preauricular cysts include:
- Simple Preauricular Cysts: These are the most common type of preauricular cyst and are characterized by a small, fluid-filled sac that is surrounded by a thin wall of tissue. Simple preauricular cysts are usually benign and do not cause any symptoms.
- Dermoid Cysts: Dermoid cysts are a type of preauricular cyst that contains skin, hair, and sweat glands. They are usually larger than simple preauricular cysts and can cause pain and discomfort.
- Fistulous Cysts: Fistulous cysts are a type of preauricular cyst that is connected to the ear canal by a narrow canal. They can become infected and cause pain and discomfort.
- Branchial Cleft Cysts: Branchial cleft cysts are a type of preauricular cyst that is formed from the remnants of the embryonic branchial cleft. They are usually larger than simple preauricular cysts and can cause pain and discomfort.
Causes
The exact causes of preauricular cysts are not well understood, but several theories have been proposed. Here are possible causes for preauricular cysts:
- Embryonic Developmental Abnormalities: Preauricular cysts are thought to occur as a result of abnormal development of the ear during embryonic stages.
- Genetics: There is some evidence to suggest that preauricular cysts may have a genetic component.
- Infections: Preauricular cysts can develop as a result of infection in the ear, such as an ear infection or a middle ear infection.
- Trauma: Trauma to the ear, such as a cut or puncture, can lead to the development of a preauricular cyst.
- Foreign Body: A foreign body in the ear, such as a bead or small object, can cause a preauricular cyst to form.
- Inflammation: Inflammation of the ear, such as from eczema or psoriasis, can lead to the formation of a preauricular cyst.
- Tumor: In rare cases, a preauricular cyst can develop as a result of a tumor in the ear.
- Congenital Abnormalities: Preauricular cysts can occur as a result of congenital abnormalities, such as cleft lip or cleft palate.
- Environmental Factors: Exposure to certain environmental factors, such as pollutants or chemicals, can increase the risk of developing a preauricular cyst.
- Autoimmune Diseases: Autoimmune diseases, such as lupus or rheumatoid arthritis, can cause preauricular cysts to form.
- Infections During Pregnancy: Women who contract infections during pregnancy, such as rubella or cytomegalovirus, may be at increased risk for developing preauricular cysts.
- Sex Chromosome Abnormalities: Sex chromosome abnormalities, such as Turner syndrome or Klinefelter syndrome, can increase the risk of developing preauricular cysts.
- Congenital Ear Deformities: Congenital ear deformities, such as microtia or anotia, can increase the risk of developing preauricular cysts.
- Chronic Ear Infections: Chronic ear infections can increase the risk of developing preauricular cysts.
- Chronic Skin Diseases: Chronic skin diseases, such as acne or rosacea, can increase the risk of developing preauricular cysts.
- Chronic Inflammatory Diseases: Chronic inflammatory diseases, such as Crohn’s disease or ulcerative colitis, can increase the risk of developing preauricular cysts.
- Chronic Ear Drainage: Chronic ear drainage, such as from a perforated eardrum, can increase the risk of developing preauricular cysts.
- Chronic Swimmer’s Ear: Chronic swimmer’s ear, also known as otitis externa, can increase the risk of developing preauricular cysts.
- Chronic Ear Wax Impaction: Chronic ear wax impaction can increase the risk of developing preauricular cysts.
- Chronic Allergic Rhinitis: Chronic allergic rhinitis, also known as hay fever, can increase the risk of developing preauricular cysts.
Symptoms
Here is a list of symptoms associated with preauricular cysts:
- Visible lump or swelling near the front of the ear
- Pain or tenderness in the area
- Itching or burning sensation
- Redness or inflammation of the skin
- Drainage or discharge from the cyst
- Foul odor coming from the cyst
- Recurrent ear infections
- Hearing loss or muffled hearing
- Tinnitus or ringing in the ear
- Balance problems
- Dizziness or vertigo
- Nausea or vomiting
- Facial weakness or drooping
- Speech difficulties
- Pain or discomfort when touching the ear
- Swelling or puffiness of the face
- Difficulty swallowing
- Breathing difficulties
- Tingling or numbness in the face
- Loss of taste or smell
It is important to note that not all individuals with preauricular cysts will experience all of these symptoms and some may not experience any symptoms at all. However, if you are experiencing any of these symptoms and have a preauricular cyst, it is important to seek medical attention to determine the best course of treatment.
Diagnosis
Here is a list of diagnostic tests and procedures that may be used to diagnose or evaluate a preauricular cyst:
- Physical examination: A physical examination of the ear is usually the first step in diagnosing a preauricular cyst. The doctor will look for any signs of redness, swelling, or discharge and will examine the cyst to see if it is tender or painful to the touch.
- History taking: The doctor will ask the patient about any symptoms, such as pain, drainage, or discharge from the cyst, as well as any medical conditions or medications that may be affecting the ear.
- Otoscopy: Otoscopy is a simple exam that uses a special instrument called an otoscope to look inside the ear. This can help the doctor to see the cyst and determine its size and shape.
- Imaging studies: Imaging studies, such as X-rays, CT scans, or MRI scans, may be used to get a better view of the cyst and the surrounding structures.
- Ultrasound: Ultrasound is a non-invasive test that uses high-frequency sound waves to create images of the ear and surrounding structures. This test can help the doctor to see the cyst and determine its size and shape.
- Aspiration: Aspiration is a simple procedure in which a needle is used to remove fluid from the cyst. This can be done in the doctor’s office and can help to determine if the cyst is infected.
- Culture: A culture of the fluid removed from the cyst can be done to determine if there is any bacteria or other pathogens present. This can help to guide treatment if the cyst is infected.
- Biopsy: A biopsy is a procedure in which a small piece of tissue is removed from the cyst and examined under a microscope. This can help to determine if the cyst is benign or malignant.
- Hearing test: A hearing test may be performed to determine if the cyst is affecting the patient’s hearing. This may include a pure-tone audiometry test, which measures the ability to hear different frequencies of sound.
- Tympanometry: Tympanometry is a test that measures the movement of the eardrum in response to changes in air pressure. This test can help to determine if the cyst is affecting the middle ear.
- Vestibular function tests: Vestibular function tests measure the function of the inner ear, which is responsible for balance. These tests may include the caloric test, which measures the response of the inner ear to warm and cool water, and the electronystagmography test, which measures eye movements in response to stimulation.
- Auditory brainstem response (ABR) test: The ABR test measures the electrical activity of the auditory nerve and the brainstem in response to sounds. This test can help to determine if the cyst is affecting the auditory nerve.
- Speech audiometry: Speech audiometry is a test that measures the ability to understand and produce speech. This test can help to determine if the cyst is affecting the patient’s speech.
Treatment
Different treatments for preauricular cysts.
- Observation: In many cases, preauricular cysts do not cause any symptoms and do not require treatment. If a preauricular cyst does not cause any issues, it can be left alone and simply observed.
- Antibiotics: If a preauricular cyst becomes infected, antibiotics may be prescribed to clear the infection. Antibiotics can be taken orally or applied topically.
- Drainage: If a preauricular cyst becomes infected and causes significant pain, drainage may be necessary. This can be done by making a small incision in the cyst to allow the fluid to drain out.
- Steroid injections: Steroid injections may be used to reduce inflammation and swelling in preauricular cysts. This can help to reduce pain and prevent infection.
- Surgical excision: Surgical excision involves removing the entire preauricular cyst, including the sac and the surrounding tissue. This is typically done under local anesthesia and may leave a small scar.
- Cryotherapy: Cryotherapy involves freezing the preauricular cyst with liquid nitrogen. This can cause the cyst to shrink and may eventually disappear.
- Laser therapy: Laser therapy can be used to destroy preauricular cysts. This is typically done with a CO2 laser, which vaporizes the cyst and the surrounding tissue.
- Electrocautery: Electrocautery involves using an electrical current to destroy the preauricular cyst. This can be done with a small probe or with a needle electrode.
- Radiofrequency ablation: Radiofrequency ablation involves using high-frequency radio waves to destroy the preauricular cyst. This is typically done with a small probe that is inserted into the cyst.
- Microwave therapy: Microwave therapy involves using microwave energy to destroy preauricular cysts. This is typically done with a small probe that is inserted into the cyst.
- Excision with marsupialization: Excision with marsupialization involves removing the cyst and creating a small opening that allows it to drain. This can help to prevent infection and reduce the risk of recurrence.
- Injection of sclerosing agents: Sclerosing agents can be injected into preauricular cysts to cause them to shrink. This can be done with a small needle, and the sclerosing agent can be a liquid or a foam.
- Injection of corticosteroids: Corticosteroids can be injected into preauricular cysts to reduce inflammation and swelling. This can help to reduce pain and prevent infection.
- Injection of anti-inflammatory agents: Anti-inflammatory agents, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can be injected into preauricular cysts to reduce inflammation and swelling.
- Injection of growth factors: Growth factors, such as platelet-rich plasma (PRP), can be injected into preauricular cysts to promote healing and reduce inflammation.
- Injection of stem cells: Stem cells can be injected into preauricular cysts to
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