What should I do if my preauricular sinus becomes inflamed, swollen, and causes fever?

If you develop inflammation, swelling, or fever associated with a preauricular sinus (also known as a preauricular fistula), this indicates an acute infection—most commonly bacterial cellulitis or abscess formation. Prompt medical evaluation is essential. Initial management typically includes oral antibiotics targeting common skin flora such as *Staphylococcus aureus* and *Streptococcus pyogenes*, for example amoxicillin-clavulanate or cephalexin. If fluctuance, significant swelling, or systemic symptoms like high fever or chills are present, incision and drainage may be required in addition to antibiotics. Warm compresses can provide symptomatic relief and support localized drainage. It is critical to avoid squeezing or manipulating the area, as this may worsen infection or promote deeper tissue involvement. Once the acute infection has fully resolved—typically after 4–6 weeks—definitive surgical excision of the entire sinus tract is recommended to prevent recurrence, as incomplete removal carries a high risk of repeated infections.

Patients should seek urgent care if they experience worsening pain, rapidly expanding erythema, fever above 38.5°C (101.3°F), lymphadenopathy, or signs of systemic toxicity. Immunocompromised individuals or those with recurrent episodes require particularly careful assessment and may benefit from microbiologic culture and sensitivity testing to guide targeted antimicrobial therapy. Long-term follow-up with an otolaryngologist is advisable for definitive surgical planning and to ensure complete anatomical excision under direct visualization, often aided by intraoperative methylene blue injection to delineate the tract.