I was born with a birth defect of the ear that is hereditary. The top part of my ear has a very small hole. (People have asked me if I've tried to pierce my ear there.) I've heard it is an open cavity from my ear to my nose. Do you have any more information on this condition?

P.G.

I think you are describing a "preauricular pit." Let's see if the description matches. 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 hole in the skin of the helical root. The typical appearance does, indeed, resemble a piercing -- the pit is that tiny.

Pits are present at birth; they form during early fetal development. In the fifth to sixth week after conception, six tiny lumps of tissue begin merging, and by the 20th 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.

Preauricular pits are, indeed, pits -- but they do NOT go all the way to your nose! The pits are skin-lined and are typically less than one inch deep.

The pits are significant for two reasons. First, they 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 cutting out the outer (visible) portion of the pit is inadequate; the surgeon must remove the entire pit. An ear, nose and throat surgeon (ENT) 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 of other ear problems. In other words, there is a greater-than-chance association of pits with other (less-visible) ear abnormalities. These "deeper" anomalies are important because they usually impair hearing to some degree. You may or may not have noticed hearing loss in this ear; the loss may be mild, and may easily have gone unnoticed on school audiograms.

I am at a serious disadvantage since I cannot see you. Your description is very suggestive of a preauricular pit, but I would have to see it to be certain that I am telling you the right thing. Before you accept what I have written as gospel, you should have an ENT examine you to confirm (or deny) what I have told you.