Painful Lumps Under the Ear: Causes and Treatments

Painful hard lump under the ear?

Hello Doctor, I am a 28-year-old female.
Two months ago, I had my upper left wisdom tooth extracted, and ten days later (I'm not sure if it's related to the extraction), I discovered a hard lump below my left ear (in the parotid gland area, level 2).
The texture is relatively hard and difficult to move.
I underwent an ultrasound-guided fine needle aspiration at National Taiwan University, which revealed the lump measures approximately 0.61 x 0.49 cm (located about 1 cm beneath the skin).
The doctor informed me that the aspiration results indicated lymphoid tissue (no malignant cells were found).
Currently, based on the ultrasound and aspiration results, I have been diagnosed with lymphadenitis.
However, after completing a week of antibiotics, the lump has not decreased in size.
Blood tests showed that my monocyte count is slightly elevated compared to normal values.
The lump still frequently causes dull pain, is tender to the touch, and the pain fluctuates, becoming more pronounced at times.
Additionally, the pain from the lump has been accompanied by discomfort behind my ear, and I have to be very careful while sleeping to avoid pressure on it.

I would like to ask:
1.
Can the results from the fine needle aspiration determine whether the lump is tumor-related or simply inflammatory? Is it possible to assess its benign or malignant nature?
2.
Would you recommend further imaging studies (such as a CT scan)? Or would another aspiration or biopsy provide more definitive confirmation?
3.
Given the frequent pain, would you suggest surgical removal? If surgery is not performed, would long-term monitoring be necessary? I am particularly concerned about the possibility of a parotid or lymph node tumor or other metastatic cancer.
I have been very anxious since the discovery and would greatly appreciate your advice.
Thank you.

Xiao Pinggai, 20~29 year old female. Ask Date: 2018/11/24

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the accuracy of fine needle aspiration is approximately 70%-80%.
To achieve a definitive diagnosis, surgical excision and pathological examination are necessary.
If surgery is planned and it is a salivary gland tumor, a preoperative CT scan will be arranged.
However, there is about a 5% risk of facial nerve injury during salivary gland tumor surgery.
It is advisable to return for a follow-up consultation with your physician if symptoms persist.
Best regards, Chi Chiao-Yun, Taichung Hospital.

Reply Date: 2018/11/24

More Info

Understanding painful lumps under the ear, particularly after a dental procedure like wisdom tooth extraction, can be concerning. In your case, the lump located near the left parotid gland (level 2) and the associated symptoms you described warrant careful consideration.

1. Fine Needle Aspiration Results: The results from your fine needle aspiration (FNA) indicating lymphoid tissue suggest that the lump is likely related to lymphadenopathy, which can occur due to various reasons, including infections, inflammatory processes, or even malignancies. However, FNA alone cannot definitively determine the nature of a lump as benign or malignant. While the absence of "bad" cells is reassuring, it does not completely rule out the possibility of a neoplasm. The presence of lymphoid tissue is more consistent with a reactive process, often due to infection or inflammation.

2. Further Imaging and Testing: Given that the lump has not resolved with antibiotics and continues to cause discomfort, further imaging studies such as a CT scan or MRI may be beneficial. These imaging modalities can provide a more comprehensive view of the lump's characteristics, its relationship with surrounding structures, and any potential abnormalities in the salivary glands or lymph nodes. If imaging suggests any atypical features or if the lump continues to grow, a repeat FNA or a core needle biopsy might be warranted to obtain a more substantial tissue sample for histopathological examination.

3. Surgical Intervention: The decision to proceed with surgical excision should be based on several factors, including the size of the lump, the degree of discomfort it causes, and the results of imaging studies. If the lump is causing significant pain or if there is a concern for malignancy, surgical removal may be the best option. This would not only alleviate symptoms but also provide a definitive diagnosis through histological examination. If the lump is determined to be benign and not causing significant issues, a conservative approach with regular monitoring may be appropriate.

In summary, while the initial findings are reassuring, your ongoing symptoms and the lump's persistence warrant further evaluation. It is crucial to maintain open communication with your healthcare provider about your concerns and to discuss the potential need for additional imaging or surgical options. Given your anxiety about the possibility of malignancy, addressing these concerns with your physician can help alleviate some of the stress associated with your condition. Regular follow-up appointments will also be essential to monitor any changes in the lump or your symptoms over time.

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