Persistent Hard Lump Behind Ear: Should I Get an Ultrasound?

There is a hard lump measuring 1.5 to 2 centimeters located behind the ear (on the mastoid bone) that is tender to the touch. It has not decreased in size to date?

Hello Doctor, I accidentally discovered a hard lump about 1.5 to 2 centimeters in size behind my left ear (on the mastoid bone or at the jugular notch) on May 5th.
I immediately consulted a physician who prescribed antibiotics and anti-inflammatory medication.
After taking the anti-inflammatory medication and antibiotics, the pain subsided, but as of May 25th, the swelling has not gone down.
The first doctor suggested it might be a cyst that is not connected to the skin (the skin can be pinched up from the lump), and the base seems to connect to the bone (there is a slight indentation at the edge of the lump, resembling a boundary).
Last Thursday, I underwent a nasopharyngoscopy, and the doctor confirmed there were no tumors.
He mentioned that I have allergic rhinitis, which has caused lymphadenitis, so he did not prescribe further antibiotics or anti-inflammatory medication, stating that this lymphadenopathy may not necessarily resolve.
Should I consider getting an ultrasound for safety, or should I try taking antibiotics and anti-inflammatory medication again? Thank you, Doctor, and I wish you all the best.

JACKY, 20~29 year old female. Ask Date: 2020/05/25

Dr. Chen Sirong reply Oncology

JACKY / 25 years old / Male
Hello, this lymphadenopathy may not necessarily resolve.
A: It might have been present for many years, and you just recently discovered it by chance.
Should I get another ultrasound for safety? A: Since it's your first discovery, you may feel more anxious, and it's fine to get another ultrasound if a physician is willing to perform it.
You could also choose to monitor it; if it increases in size, then you should get another ultrasound.
Should I also try taking antibiotics and anti-inflammatory medications? A: If you have taken them and there has been no change, you may not need to continue.
Taking more may not necessarily be beneficial.
Wishing you all the best, Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2020/05/25

More Info

It sounds like you are dealing with a persistent hard lump behind your left ear, which has raised some concerns for you. Based on your description, it seems that you have already consulted with a physician who has prescribed antibiotics and anti-inflammatory medication, which helped alleviate the pain but did not reduce the swelling. The initial assessment suggested that the lump might be a cyst that is not connected to the skin, and it appears to be associated with the underlying bone.

Given that the lump has not resolved after a few weeks of treatment, and considering that you have undergone a nasopharyngoscopy that ruled out tumors, it is understandable that you are seeking further evaluation. Here are some considerations regarding your situation:
1. Nature of the Lump: The characteristics you described—such as the lump being hard, measuring about 1.5 to 2 centimeters, and having a distinct border—could suggest a few possibilities. These might include a sebaceous cyst, a lymph node that has become reactive due to inflammation, or even a benign bone growth. The fact that it is not painful and has not changed significantly in size is somewhat reassuring, but it still warrants further investigation.

2. Ultrasound Examination: An ultrasound can be a useful tool in evaluating soft tissue masses. It can help determine the nature of the lump (solid vs. cystic), its relationship to surrounding structures, and whether there are any concerning features that might suggest a need for further intervention. Given that the lump has persisted despite treatment, an ultrasound could provide valuable information and help guide your next steps.

3. Continued Medication: While antibiotics and anti-inflammatory medications can be effective for infections or inflammatory conditions, if the lump is not responding to these treatments, it may not be the right approach for your situation. If your physician believes that the lump is related to allergic rhinitis and lymphatic inflammation, it might be worth discussing the potential benefits of continuing or adjusting your medication regimen.

4. Follow-Up with a Specialist: If you have not already done so, consider consulting an ear, nose, and throat (ENT) specialist or a dermatologist who specializes in skin and soft tissue lesions. They can provide a more detailed examination and may recommend further imaging or even a biopsy if necessary.

5. Monitoring: If the lump is not causing any significant symptoms and is not growing, your physician may suggest a watchful waiting approach. However, it is essential to have regular follow-ups to monitor any changes in size or symptoms.

In conclusion, it would be prudent to pursue an ultrasound to gain more insight into the nature of the lump behind your ear. This imaging study can help clarify the diagnosis and inform your treatment options moving forward. Additionally, maintaining open communication with your healthcare provider about your concerns and symptoms is crucial in managing your condition effectively.

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