Are babies with ear skin tags at risk for urinary tract anomalies?

Urinary Tract Anomalies in Babies with Ear Skin Tags

Babies with isolated ear skin tags do not require routine renal ultrasonography as they are not at significantly increased risk for urinary tract anomalies. 1

Evidence Assessment

Relationship Between Ear Tags and Urinary Tract Anomalies

• Studies examining the association between isolated ear tags and urinary tract anomalies show conflicting results:
  • Kohelet and Arbel (2000) found urinary tract abnormalities in 8.6% of infants with isolated preauricular tags, suggesting a significant association 2
  • However, Deshpande and Watson (2006) found only one infant (1.1%) with isolated ear anomalies had a transient unilateral pyelectasia, a prevalence no different from the general population 1
  • A meta-analysis by Ramos et al. (2006) found a modest increased risk (OR 1.56,95% CI 1.25-1.94) of renal tract anomalies in infants with isolated mild external ear malformations 3

When Renal Imaging Is Warranted

• Renal imaging is indicated when ear anomalies are accompanied by:

  • Other malformations or dysmorphic features
  • Family history of deafness
  • Auricular and/or renal malformations
  • Maternal history of gestational diabetes 4

• The presence of multiple congenital anomalies significantly increases the risk of renal abnormalities:

  • 33% of patients with multiple congenital anomaly syndromes and ear anomalies had renal anomalies
  • Only 11% of patients with isolated ear anomalies had renal anomalies 4

Clinical Approach

Assessment of Ear Anomalies

• Carefully examine for other associated anomalies that might suggest a syndromic condition 4
• Look specifically for:
  • Facial asymmetry
  • Eye abnormalities (colobomas)
  • Choanal atresia
  • Jaw hypoplasia
  • Branchial cysts or sinuses
  • Cardiac murmurs
  • Distal limb anomalies
  • Anorectal malformations 4

Monitoring for Urinary Tract Issues

• For babies with truly isolated ear tags (no other anomalies):

  • Routine renal ultrasonography is not warranted 1
  • Monitor for signs of urinary tract infection which could be the first presentation of an underlying anomaly 5

• For babies with ear tags plus other anomalies:

  • Perform renal ultrasonography to evaluate for structural renal anomalies 5
  • Consider referral to urology if abnormalities are found 5

Potential Pitfalls

• Failing to distinguish between truly isolated ear tags and those associated with syndromes that have higher rates of renal anomalies 4
• Over-investigating babies with isolated ear tags, leading to unnecessary testing and parental anxiety 1
• Missing syndromic conditions where ear anomalies may be subtle but renal anomalies are common (e.g., branchio-oto-renal syndrome, CHARGE association, Townes-Brocks syndrome) 4

Summary

The evidence does not support routine renal ultrasonography for babies with truly isolated ear skin tags. However, a thorough physical examination is essential to identify any additional anomalies that might suggest a syndromic condition, which would warrant renal imaging due to significantly higher risk of urinary tract anomalies.