This picture depicts an infected congenital sinus in front of the ear.
The formation of the outer ear occurs during the embryonic period in the womb. It is caused by the fixation of six pieces. A hole could remain in front of the ear due to a defect in the process. There is a sac under this hole covered with skin. Secretion may collect inside the sac.
The sac may periodically get infected with bacteria resulting in a pus-filled mass which needs drainage and antibiotics. Once the wound heals, it is necessary to remove the sac through surgery. A blue dye will be injected through the hole. This helps locate and identify the sac beneath the skin. The coloured area will be removed and sutured. After about five days, the sutures will be removed.
The mere presence of a hole in front of the ear, without infection, does not require surgery.