Ear Indentations on an Infant

Abstract

An 11-month-old boy was brought to our University of Florida Child Protection Team by child welfare services after his foster mother had noticed what appeared to be “10 healing puncture wounds” on the infant’s ears. The child protective investigator reported that the boy had “indentations on his ears as though someone was trying to pierce them.” The boy had been sheltered from his biological mother approximately 2 weeks earlier because of the mother’s substance use. The boy had undergone a mandatory foster care examination within 72 hours of his foster care placement. No ear abnormality was documented at that time. His primary care provider’s medical record was also reviewed. Although the child had a history of ear infections and a hospitalization for bronchiolitis, no mention of an abnormal external ear examination was documented. The boy was brought to the University of Florida Child Protection Team for medical evaluation by a transporter for child welfare services. Since there was no caregiver present, no additional medical or social history was obtained. Physical Examination The boy had average weight and length for his age, with a head circumference that was 25% for his age. He was alert and socially interactive. He had a small umbilical hernia that was reducible. An ear examination revealed multiple indentations on the posterior aspect of the bilateral pinnae (Figures 1-3) that were consistent with bilateral posterior helical pits or posterior earlobe indentations (PELI). The rest of his examination findings were unremarkable. Discussion Most pediatric health care providers are familiar with preauricular sinuses (ear pits), as they are a common abnormality that generally do not require treatment. Preauricular sinuses are usually located adjacent to the external ear and can be unilateral or bilateral. Approximately 25% to 50% of cases are bilateral preauricular sinuses, which increases the likelihood that they are inherited.1 In 3% to 10% of cases, preauricular sinuses are associated with hearing and renal abnormalities.1 Studies suggest that further workup is only necessary when the preauricular sinuses are accompanied by another malformation or dysmorphic feature.1 Our patient had posterior helical ear pits (PHEP) or indentations. Unlike preEar Indentations on an Infant