Painful Lumps Below the Earlobe: Causes and Treatments - Otolaryngology

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When it comes to painful lumps below the earlobe, there are several potential causes that could explain your symptoms. The lump you described, measuring approximately 2-4mm and being painful to touch, along with the redness of the skin, could indicate a few different conditions.

1. Lymphadenopathy: One common cause of lumps in this area is swollen lymph nodes. Lymph nodes can become enlarged due to infections, inflammation, or other medical conditions. If you have recently had an upper respiratory infection or any other type of infection, this could be a reason for the swelling and tenderness.

2. Sebaceous Cyst: Another possibility is a sebaceous cyst, which is a benign growth that can occur when a sebaceous gland becomes blocked. These cysts can sometimes become inflamed or infected, leading to pain and redness.

3. Infection: The presence of pain and redness could also suggest an infection, such as cellulitis or an abscess. If the lump is warm to the touch and you have systemic symptoms like fever, this could indicate a more serious infection that may require antibiotics or drainage.

4. Ear-related Issues: Given that you mentioned having a preauricular sinus (ear preauricular fistula), it is possible that the painful lump could be related to this condition. Preauricular sinuses can sometimes become infected or inflamed, leading to discharge and pain. The white discharge you mentioned could be a sign of infection, especially if it is accompanied by redness and a foul smell.

5. Other Causes: Other potential causes could include dermatological conditions, such as folliculitis or other skin infections, or even more serious conditions like tumors. However, these are less common.

Regarding your question about whether surgery is necessary, it depends on the underlying cause of the lump. If it is determined to be an infected cyst or a preauricular sinus that is recurrently infected, surgical intervention may be warranted to remove the source of infection and prevent future occurrences. On the other hand, if it is a swollen lymph node due to a transient infection, it may resolve on its own with time and appropriate treatment.

It is crucial to consult a healthcare professional for a thorough examination and appropriate diagnostic tests, such as an ultrasound or possibly a biopsy, to determine the exact nature of the lump and the best course of action. If you notice any worsening symptoms, such as increased redness, swelling, fever, or persistent pain, it is advisable to seek medical attention promptly.

In summary, while the lump below your earlobe could be due to several benign causes, the presence of pain, redness, and your history of a preauricular sinus suggests that a medical evaluation is necessary. A healthcare provider can offer a definitive diagnosis and recommend appropriate treatment, which may include medication or surgical options depending on the findings.