a Small Lump Behind the Ear: When to Seek Medical Advice

Swelling behind the ear?

Hello Doctor, my father is in his 60s, and I noticed a small swelling on his cheek behind the right earlobe, measuring about 1 cm in length and 0.7 cm in width.
He does not experience any discomfort, and the swelling is not painful when touched.
I would like to ask you what this symptom might be and whether it is necessary to seek medical attention.
Thank you.

Niming, 30~39 year old female. Ask Date: 2017/01/16

Dr. Chen Taicheng reply Family Medicine

● A lump behind the ear is commonly seen as a subcutaneous mass, such as an epidermoid cyst (also known as a sebaceous cyst or pilar cyst).
These cysts typically enlarge and may spontaneously regress over time.
Occasionally, a gray-black or deep blue opening may be visible, and squeezing the cyst may release a white, pasty substance; however, if the opening is too deep, nothing may be expelled.
Other possibilities include sebaceous gland hyperplasia, lipomas, and fibromas.
If the lump has been present since childhood, a branchial cleft cyst (a developmental anomaly from the first pharyngeal arch during embryogenesis) should be considered.
● Considering your father's age, a painless lump behind the ear may warrant evaluation for lymphadenopathy, lymphadenitis, or a parotid gland mass.
● If it is a skin tumor, the vast majority are benign; however, there is a very small chance of malignancy with lymph nodes.
It is recommended to follow this order for evaluation: Dermatology (to rule out subcutaneous tumors) → Otolaryngology (to rule out lymph node and parotid gland diseases).
Wishing your father good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department sends his regards.

Reply Date: 2017/01/16

More Info

When it comes to a small lump behind the ear, particularly in someone over the age of 60, there are several potential causes that could explain the symptom you’ve described. Given that your father is experiencing a painless lump measuring approximately 1 cm in length and 0.7 cm in width, it is essential to consider various possibilities, including benign and malignant conditions.

One common cause of a lump in this area is a lymph node enlargement. Lymph nodes can swell due to infections, inflammation, or even benign conditions such as cysts. Infections in the ear, throat, or scalp can lead to reactive lymphadenopathy, where the lymph nodes become enlarged as they work to fight off the infection. If the lump is indeed a lymph node, it may resolve on its own once the underlying issue is addressed.

Another possibility is a sebaceous cyst, which is a non-cancerous growth that can occur when a hair follicle becomes blocked. These cysts are typically painless and can vary in size. They are generally harmless but can become infected or inflamed, leading to discomfort.

In some cases, the lump could be a lipoma, which is a benign tumor made of fat tissue. Lipomas are usually soft, movable, and painless, and they typically do not require treatment unless they cause discomfort or cosmetic concerns.

However, it is crucial to consider the potential for more serious conditions, such as malignant tumors. While the lump being painless and not causing discomfort is reassuring, any new growth in an older adult should be evaluated to rule out cancer. Conditions such as squamous cell carcinoma or basal cell carcinoma can present as lumps in the head and neck region, and early detection is key to successful treatment.

Given these possibilities, it is advisable to seek medical attention for a proper evaluation. A healthcare provider, particularly an ear, nose, and throat (ENT) specialist, can perform a physical examination and may recommend imaging studies, such as an ultrasound or CT scan, to better understand the nature of the lump. In some cases, a biopsy may be necessary to determine the exact cause of the lump.

In summary, while the lump behind your father's ear may be benign, it is essential to have it evaluated by a healthcare professional, especially considering his age. Early diagnosis and intervention can lead to better outcomes, whether the lump is benign or requires further treatment. It is always better to err on the side of caution when it comes to new growths in older adults.

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