A previously healthy 27-year-old female visited our clinic for evaluation of a second hole in her right ear. The patient reported that the hole had been present since infancy, and it was likely congenital. She did not have any severe symptoms with the exception of slight ear discomfort several times per year.A hole 4 mm in diameter was found at the anteroinferior part of cavum conchae of the right auricle, which was separate from the true external auditory canal (Figure 1: arrow), and which contained a small amount of scurf. Figure 1. An extra hole was found at the cavum conchae of the patients right auricle Computed tomography revealed an extracranial blind-ended sinus beneath the true external auditory canal (Figure 2: arrow). Audiometry was normal on both sides, and no other malformations were found around the acoustic organs. Figure 2. Computed tomography revealed an aerated blind-ended sinus beneath the true external auditory canal Although the definite pathogenesis of the second hole was unknown, it seemed to be a type of first branchial cleft anomaly.1 Usually, the treatment of the anomaly is complete surgical excision of the sinus, fistula, or cyst.2 In this case, however, surgery was not selected because the patient had no history of active infection in the sinus, which opened widely and was well aerated. The patient was followed up, and the hole was periodically cleaned.

A previously healthy 27-year-old female visited our clinic for evaluation of a second hole in her right ear. The patient reported that the hole had been present since infancy, and it was likely congenital. She did not have any severe symptoms with the exception of slight ear discomfort several times per year.A hole 4 mm in diameter was found at the anteroinferior part of cavum conchae of the right auricle, which was separate from the true external auditory canal (Figure 1: arrow), and which contained a small amount of scurf. Figure 1. An extra hole was found at the cavum conchae of the patients right auricle Computed tomography revealed an extracranial blind-ended sinus beneath the true external auditory canal (Figure 2: arrow). Audiometry was normal on both sides, and no other malformations were found around the acoustic organs. Figure 2. Computed tomography revealed an aerated blind-ended sinus beneath the true external auditory canal Although the definite pathogenesis of the second hole was unknown, it seemed to be a type of first branchial cleft anomaly.1 Usually, the treatment of the anomaly is complete surgical excision of the sinus, fistula, or cyst.2 In this case, however, surgery was not selected because the patient had no history of active infection in the sinus, which opened widely and was well aerated. The patient was followed up, and the hole was periodically cleaned.