COMMENTARY

Preauricular Skin Tags or Ear Pits and Hearing Impairment

William T. Basco, Jr., MD, FAAP

Disclosures

May 11, 2009

Preauricular Skin Tags and Ear Pits Are Associated With Permanent Hearing Impairment in Newborns

Roth DA, Hildesheimer M, Bardenstein S, et al
Pediatrics. 2008;122:e884-890

Summary

Preauricular skin tags or ear pits (PSEPs) anterior to the external ear are generally considered minor anomalies. Partly as a result of mixed findings in studies, when isolated and not occurring in a child with obvious major malformations, preauricular skin tags have not been considered a symptom of increased risk for hearing impairment (HI).

This study was conducted at a single medical center in Israel. All newborns completed hearing screening with transient otoacoustic emissions. However, all newborns with PSEPs were considered "high risk" and therefore had confirmatory testing with auditory brainstem response regardless of nursery hearing screening results. This allowed the authors to determine the rates of HI associated with PSEPs, and the authors could determine how well nursery otoacoustic emissions screening identified these infants.

The authors defined HI as either uni- or bilateral, conductive or mixed, of greater than 25 dB. Of all infants tested, 0.93% had HI. Data were collected from 1997 to 2004, and 637 children were identified with PSEPs during the study period. Of these patients, 587 had PSEPs and no additional risk factors for HI. In this group, the rate of sensorineural or conductive HI was 0.34%.

The rate of sensorineural or conductive HI in infants without PSEPs and without risk factors was 0.05%, producing an adjusted odds ratio of 6.7 (95% confidence interval [CI], 1.59-27.88) for HI in patients with PSEPs vs normal infants. In the group of 39 infants with PSEPs and additional risk factors for HI, the rate of sensorineural or conductive HI was 7.7%. The adjusted odds ratio for HI when compared with the group of infants with risk factors (but no PSEPs) was 4.1 (95% CI, 1.23-13.66). Finally, in a group of 11 infants with PSEPs and major malformations ("very high-risk" group), the rate of sensorineural or conductive HI was 91%.

The authors concluded that PSEPs are associated with an increased risk for HI regardless of risk stratum. Only one of the infants later identified with HI was not identified by the screening method of otoacoustic emissions.

Viewpoint

I think that the take-home message of this study includes paying attention to what might be considered isolated physical findings. The 2007 Joint Committee on Infant Hearing statement lists ear pits as one of the physical findings associated with higher risk for HI.[1] However, the question remains as to what providers should do when they identify infants with such isolated anomalies. These data would suggest that routine newborn screening programs will identify the hearing impaired among these children, but perhaps additional clinical concern would help clinicians discover those who might present later with language delay or other signs of HI.

Abstract

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