Lump behind the ear: causes and which doctor to see

For lump behind the ear you can first see: Ear, Nose & Throat (ENT) or Pediatrics or Dermatology. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: a pea- to hazelnut-sized lump behind the ear; tenderness to touch; an itchy scalp or a sore on the scalp (the source of infection); redness and warmth (with infection). Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: a lymph gland enlarged by scalp infection, head lice or inflamed dandruff; throat, ear and tooth infections; viral infections such as rubella and glandular fever; sebaceous (epidermoid) cyst and lipoma; mastoiditis (middle ear infection spreading to the bone); rarely, lymphoma. Only a doctor’s examination can determine the exact cause.

Lymph glands reacting to infection shrink within 2–6 weeks after the infection passes. Cysts usually do not go away on their own; if they become inflamed or bothersome they are removed with a small procedure. Mastoiditis needs emergency treatment.

It is more common in: children (enlarged lymph glands are common); people with scalp problems; people who often get ear infections.

On examination, the consistency, size and mobility of the lump are assessed. If needed, an ultrasound, blood count and rarely a biopsy are done; if mastoiditis is suspected, a CT is requested.

Get scalp and ear infections treated. Check children for head lice.

An ENT specialist deals with it; for children, a paediatrician assesses it first.

Most are harmless and shrink after an infection. Glands that do not shrink for weeks, are hard and are growing should be investigated.

Most often it is an inflamed hair follicle or a sebaceous cyst.

If the answer to any of these questions is yes, call 112 without delay: “Is the area behind the ear red and very painful, is the ear pushed forward, and is there high fever?” “Is there headache, a stiff neck or a change in consciousness?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: the lump has not shrunk in 2–4 weeks; it is hard, fixed and growing; there is ear pain and discharge; there is fever and night sweats.