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In many cases the pre-auricular sinus is symptomless and is simply noted casually by the patient or the examining doctor. In more troublesome cases there is repeated discharge of mucoid or thickened secretion from the sinus tract. In the most severe cases there are bouts of infection with obstruction of the sinus and the formation of an infected cyst which develops into an abscess, with pain, swelling and reddening of the overlying skin. Spontaneous rupture of such an abscess may occur or incision and drainage may be necessary; such history not infrequently pre-dates the patient’s consultation with the otologist.