Ever noticed a tiny, pin-sized opening right where the top of someone's ear meets their face? It looks almost like a forgotten piercing or a stray blackhead that won't go away. Most people just ignore them. But if you're the one looking in the mirror wondering why you have a hole near the ear, you've probably realized it's been there since the day you were born.
It isn't a scar. It isn't an injury. It’s actually a congenital feature called a preauricular pit.
Some cultures call them "wealth marks," suggesting that if you have one, you're destined for riches. Scientifically? It's just a quirk of how your ears formed while you were still a tiny embryo in the womb. They are surprisingly common once you start looking for them, appearing in about 0.1% to 0.9% of the population in the US and Europe, though the numbers jump way higher—up to 10%—in parts of Asia and Africa. Honestly, most people live their whole lives without even thinking about them until they get itchy or, unfortunately, start to smell a bit funky.
What is a Preauricular Pit, Exactly?
Basically, it's a sinus tract. Think of it like a tiny, narrow tunnel under the skin that shouldn't really be there but decided to hang out anyway. These pits are usually located on the "crus" of the helix—that’s the technical term for the ridge of cartilage right above your ear canal.
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How does it happen? Biology is messy. During the sixth week of gestation, your ears start forming from six little bumps of tissue called the hillocks of His. Usually, these bumps fuse together perfectly to create the complex shape of the human ear. But sometimes, they don't quite zip up all the way. That tiny gap left behind becomes the hole near the ear. It’s a literal remnant of your development.
It’s almost always harmless. You might have one on just the right side, or both. If it’s on both sides, there’s a much higher chance it’s a hereditary trait passed down through your family. If your mom has one, there's a decent shot you do too.
Is It a "Fish Gill"?
There is a popular theory floating around the internet—mostly sparked by evolutionary biologist Neil Shubin—that these holes are an evolutionary "leftover" from fish gills.
It sounds cool. It makes for a great "did you know" fact at parties. But it's a bit more nuanced than that. While it’s true that the structures (pharyngeal arches) that form our ears are the same ones that form gills in fish, calling a preauricular pit a "gill" is a bit of a stretch. It’s more like a glitch in the transition from ancient aquatic structures to modern human ones. We aren't secretly part-mermaid. We’re just walking around with a very specific, very old biological footnote on our faces.
When the Hole Near the Ear Becomes a Problem
For 90% of people, these pits are just "there." You forget about them. But because they are essentially little pouches lined with skin cells, they can collect debris.
Skin sheds. Sebum (oil) builds up. Because the hole is so narrow, that gunk has nowhere to go. If you’ve ever squeezed one—which, by the way, doctors really recommend you don't do—you might notice a white, cheesy substance coming out. It smells. Bad. That’s just macerated skin cells and oils.
The real trouble starts with infection.
Signs of an Infected Pit
If that little hole starts looking angry, you’ve got a problem. Watch out for:
- Redness and swelling around the opening.
- Pain when you touch your face or ear.
- Pus or fluid draining out (it won't be that dry, cheesy stuff; it'll be yellow or green).
- A fever (that’s when you know the infection is systemic).
Once a pit gets infected, it can turn into an abscess. This is basically a localized pocket of infection that is incredibly painful. If you ignore an infected hole near the ear, it can lead to cellulitis, which is a much nastier skin infection that spreads.
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The Connection to Other Health Issues
Most of the time, a pit is just an isolated "whoopsie" by nature. However, doctors sometimes use them as a "red flag" to look deeper.
There is a rare condition called Branchio-Oto-Renal (BOR) syndrome. It’s a genetic disorder that affects the development of the neck (branchial) tissues, the ears (oto), and the kidneys (renal). If a baby is born with a preauricular pit and other symptoms like hearing loss or cysts on the neck, doctors usually order a kidney ultrasound.
Does this mean you need to panic if you have a hole? No. If you've made it to adulthood and your kidneys work fine and you can hear this article being read aloud, you likely don't have BOR. But for newborns, it's a standard check-up procedure just to be safe.
Treatment: To Close or Not to Close?
If your pit is just sitting there being a pit, do nothing. Seriously. Leave it alone. Don't poke it with a needle, don't try to "clean" it with a Q-tip, and definitely don't try to drain it yourself. You’ll just push bacteria deeper into the tract and cause the very infection you’re trying to avoid.
If it does get infected, you'll need a round of antibiotics. Usually, a doctor will prescribe something like cephalexin or amoxicillin-clavulanate. If an abscess forms, they might have to do an "incision and drainage"—which is exactly as fun as it sounds.
Surgical Removal (Excision)
For people who deal with chronic, recurring infections, the best bet is often to have the whole thing removed. This isn't just a surface-level "snip." Remember, this is a tunnel. A surgeon has to track the entire sinus tract and remove every bit of the lining. If they leave even a tiny piece of the tract behind, the pit can grow back or continue to get infected.
The procedure is usually called a "supra-auricular approach." It’s an outpatient surgery, meaning you go home the same day. Most surgeons will wait until the active infection is completely gone before operating, because inflamed tissue is harder to work with and increases the risk of the pit returning.
Living With a Preauricular Pit
If you're part of the "tiny hole club," your daily routine shouldn't change much.
Keep it clean, but keep it simple. Use a gentle soap and water during your shower. Don't go digging. If you notice it starting to feel "full" or slightly tender, you can use a warm compress to help encourage natural drainage, but that's about the limit of home care.
Interestingly, some people actually get these pits pierced. Professional piercers generally advise against this. Because the pit is a blind-ended tract (it goes somewhere and stops), putting jewelry through it can trap bacteria even more effectively than the hole already does. It’s a recipe for a massive infection. If you want a piercing, get a forward helix piercing near the pit, but stay away from the hole itself.
Summary of Actionable Steps
Having a hole near the ear is a minor anatomical variation for the vast majority of people. Here is how you should handle it:
- Observe: Take a look at the area. Is there just one hole? Is it red? If it looks like a clean, dry pinprick, you are in the "safe zone."
- Hygiene: Wash the area with mild soap. Do not use harsh chemicals or alcohol inside the hole, as this can irritate the delicate lining of the tract.
- Hands Off: Resist the urge to squeeze. It’s tempting, but it’s the primary cause of infections in these structures.
- Consult a Professional: If you notice a foul smell that won't go away, or if the area becomes painful and swollen, see a GP or an Ear, Nose, and Throat (ENT) specialist. They can determine if you need antibiotics or if a surgical consult is necessary.
- Pediatric Check: If you notice this on your newborn, mention it to your pediatrician. They will likely do a quick check of the baby’s hearing and potentially screen for other developmental markers, just to be thorough.
The human body is full of these little glitches—extra ribs, hitchhiker's thumbs, and yes, tiny holes near the ear. They don't make you "weird." They just make your biological history a little more visible on the surface. Unless it's causing you pain, consider it a unique feature of your own personal anatomy.