Saturday, August 25, 2018

Preauricular (Ear) Pit

If you're anything like me, you read the title and thought, "What is an ear pit?".  I had never heard of it either, until Amada. When we went to the hospital to pick her up, I noticed a small hole next to where the ear attaches to the face. It almosts looks like a piercing. I asked the nurse about it and she explained it was an "ear pit".  I did some research, then asked the Pediatrician at her 2 week check up. I was reassured that most of the time they don't cause any problems.

Sorry this picture is a little blurry, but if you look closely you can see the pinpoint hole.  Amada did have some issues with ear infections, and eventually had to have tubes inserted around 2 years old,  but that was unrelated to the ear pit.

Around that same time, we also discovered that she had an abnormality with her bladder/kidney, called vesicoureteral reflux. Basically what happens is when the person urinates, urine flows back up the ureter to the kidney. This can cause frequent bladder/kidney infections. Amada was prescribed a low dose of antibiotics to be taken daily. She eventually went on to have surgery in 2013 to repair this defect.

A couple of years after this, we began noticing pus leaking from her ear pit. It was only a very small amount so we continued to monitor it. This continued on an almost daily basis. We made an appointment with her ENT doctor. She recommended surgery to excise the sinus tract of the ear pit that is under the skin. This would close the hole and prevent further infection. We proceeded with the surgery, but had some issues with infection afterwards. She had to be on a couple different types of antibiotics but her incision ended up healing.

Incision site as it was healing (2016).

Fast forward to July 2018, more than 2 years after this surgery. One day Amada wakes up complaining of ear pain, except it's not inside the ear canal. It is at the site where her ear pit had been removed. I was shocked! I didn't think we would ever have to worry about an infection coming back to that site. I immediately took her in to urgent care where they confirmed it was an abscess. They recommended making a small incision to allow the infection to drain out. Amada was not about to let that happen. I asked if we could start antibiotics and let me try to get a hold of ENT. In the mean time, we were also giving her Motrin for the pain and doing warm compresses.

In the middle of the night she was unable to sleep because the pain was worsening so we took her to the Emergency Room. Once again they recommended opening it up to let it drain. Amada kept saying she wanted to be asleep for the procedure. The ER doctor recommended intranasal Versed to sedate her. Unfortunately she didn't like the idea of that either. It took 4 of us holding her to get the medication in her. She was able to rest for a while. When the ER doctor came back in she decided to do a needle aspiration instead. Even with the pre-medication in her, Amada became extremely combative.  Again it took 4 of us holding her in order for the doctor to perform the needle aspiration. We didn't want her or anyone else to get hurt, but she was NOT going to hold still at all. She ended up pulling away from the needle, but the doctor was able to extract some pus which she was able to send for a culture. 

After the needle aspiration.
For the next 24 hours she had some reprieve from the pain. Then it seemed the infection was spreading, as the pain was radiating down into her jaw. Thankfully I was able to get her an appointment with ENT. Again they recommended making an incision to drain it. Amada was NOT going to let them touch her in the office. They were able to add her on to the surgery schedule for the next morning however. 

Amada cuddling Marty, the therapy dog, at the Surgery Center

Her ear was healing up nicely after the procedure until she finished her antibiotics. The swelling and pain returned. The ENT gave her a refill of antibiotics so she could remain on them through the weekend. She had another follow up appointment on Tuesday and found out the infection remained and she would need to have surgery again the following day. Wednesday was supposed to have been her first day of school. Not just her first day of school, but her first day of public school.

This surgery did not go as smoothly as the last one. There was no therapy dog available and Amada's anxiety was over the top. The anesthesiologist ended up having to give her an injection of Ketamine and Versed to get her back to the operating room. The actual surgery itself went well. The doctor reported there was still quite a bit of infection present and some scar tissue from the original surgery. She gave Amada a different antibiotic again. The recovery from this surgery took much longer due to the extra medication that had to be given prior to surgery.

Amada was to follow up with her doctor in 2 days to change her bandage, but the doctor was concerned with the amount of anxiety Amada was having. We were able to consult with her Pediatrician who gave us a prescription of Ativan for Amada to take before her appointment. Even still, she was a fighter.

We continued to go to the doctor daily for wound packing and dressing change for 10 days. We even had to learn to pack her wound with gauze at home. Amada definitely tolerated it better as time went on. Of course rewarding her for cooperating (aka bribery) helped also!

The wound is finally closed. The doctor has ordered an MRI to check for any cyst remnants. We are hoping that Amada will not need any future surgery on this, but if she does, we will manage.

You can also watch the video I created Amada's Journey: Preauricular Ear Pit on our YouTube channel.

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