Appearance of lump behind ear or knot behind the ear is very scary thing to experience. These lumps or knots behind the ear can be small in size or large; but they are almost always harmless. The lump behind ear of course, need medical attention, but are rarely an indication of a fatal or life-threatening problem. The lumps behind ear or knot behind ear can be painful or painless depending on what causes the lump behind the ear. One must consult a doctor when there are lumps or knots present behind the ear or anywhere in the body. Early diagnosis and treatment helps to prevent future complications.

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Lump Behind Ear or Knot Behind Ear

What Causes Lump or Knot Behind the Ear?

  1. Skin Diseases-

    1. Boil or Furuncle
    2. Carbuncle
    3. Impetigo
    4. Acne
  2. Subcutaneous Abscess

  3. Enlarged Lymph Node

  4. Sebaceous Cyst

  5. Benign Tumor

    1. Lipoma
    2. Dermatofibromas
    3. Keratoacanthomas
    4. Granulomas
  6. Malignant Cancer

  1. Basal Cell Carcinoma
  2. Squamous Cell Carcinoma
  3. Melanoma

Causes of Lump or Knot Behind the Ear

Skin Diseases That Can Cause Lump Behind Ear or Knot Behind Ear-

  1. Boil or Furuncle- Infection of sweat gland or hair follicle causes a small swelling in the beginning. Such swelling is known as pustules since it contains small amount of pus. The swelling if ignored gets larger and become red as well as painful. Occasionally the purulent cystic swelling known as furuncle or boil ruptures and pus flows over the skin. The bacteria within the secretion often causes spread of infection when another individual shares the towel or object that is contaminated with the pus. Occasionally infection spreads to adjacent tissue or distant organs through blood. The spread of bacteria through blood is known as bacteremia. The most bacterial infection resulting in furuncle is caused by staphylococcus aureus bacteria.
  2. Carbuncle-The bundle of several infected furuncle forms a carbuncle. Carbuncle is lot more painful and rapidly spread in surrounding subcutaneous tissue and skin. Carbuncle often spreads into blood vessels and causes bacteremia.
  3. Impetigo- Impetigo is a skin infection caused by staphylococcus and streptococcus bacteria. The condition forms a red sore that grows in size. The sore bump filled with serous fluid is known as blister. The blister looks like bump or knot and causes severe itching in surrounding skin. Most children and adult suffering with impetigo cannot avoid scratching. The fluid from rupture blister contains bacteria and spreads the infection to child or adult who comes in contact with contaminated towel, object or skin.
  4. Acne-Acne is quite a common skin condition. Sweat gland and hair follicle gets inflamed following blocking or clogging of the sweat gland or hair follicles in the skin. The hair follicle is clogged because of over secretion of sweat as well as sebum. Sebum contains fatty tissue and dead skin cells. This causes development of pimples or bumps, which can further grow into painful lumps or knots. Bump cause by acne behind the ear is less common than facial acne. The causes of acne include hormonal changes, stress, staph infections or a genetic predisposition.

Subcutaneous Abscess Can Cause Lump Or Knot Behind Ear

Subcutaneous abscess is a caused by skin infection unlike infection of sweat gland and hair follicle. The infection is caused by scratching the skin or bacteremia. Isolated abscess behind the ear is rare. But when it occurs the bump or knot is form by soft cystic swelling. The bump or knot feels warm when touched and also looks yellowish brown filled with pus. The pus is form by thick, fluid that contains dead cells, dead white blood cells, serous fluid and bacteria. Abscesses behind the ear or anywhere are commonly painful and warm to touch. Most abscesses are caused by staphylococcal and streptococcus bacteria.

Enlarged Lymph Node: Cause of Lump or Knot Behind Ear

Lymph node connects lymphatic vessels. Lymphatic vessels carry whitish clear fluid that contains metabolites, dead cells and minerals. Lymph node is a tiny nodular gland that filters bacteria and dead cells. Lymph node filters metabolites and bacterial when lymph flows through lymph node. The lymph node then enlarges in size and become tender or painful. Multiple enlarged lymphnode causes condition known as lymphadenopathy. Lymph nodes are tiny structures, which are present all over our body as well as behind the ears. Lymph node swelling occurs as a result of infection, inflammation or cancer. Lumps node behind ear enlarges when child or adult suffer with ear and mastoid bone infection.

Otitis media is a condition where there is infection of the ear. These infections can be viral or bacterial. Any type of ear infection causes pain, swelling and accumulation of fluid. Ear infection causes enlarged painful lymph node that lies behind ear. Antibiotics help in relieving symptoms and fighting the infection. Similarly, mastoiditis causes enlarged painful lymph node behind ear. Mastoiditis is an infection of the mastoid bone, which is found behind the ear. Mastoiditis develops if an ear infection is left untreated resulting in a more serious infection, which is known as Mastoiditis. There can be development of pus-filled cysts, which can be visible as lump behind ear or knot behind ear.

Sebaceous Cysts: Cause of Lump Behind Ear or Knot Behind Ear

Cysts are one of the common causes of knots or lumps behind the ears. Sebaceous cysts are noncancerous bumps, which develop under the skin. Common regions where they occur include the head, neck and torso. Sebaceous cyst develops around the sebaceous gland. The function of this gland is production of oil for lubrication of skin and hair. Many of the times sebaceous cysts produce little or no pain. They can be, however, irritating or uncomfortable to the patient. Epidermal cysts can also develop behind the ear leading to appearance of lumps or knots behind the ear. Accumulation of keratin leads to development of epidermal cysts. These can occur anywhere in the body including behind the ears. It is important to treat any type of cysts, as they can become infected.

Benign Skin Tumor1: Cause of Lump Behind Ear Or Knot Behind Ear

Benign skin tumor is painless and appear as soft and movable lump. which can develop from the tissues of the salivary glands towards the region behind the ears. The benign tumors may remain the same size or can grow larger. Cholesteatoma is a type of growth, which occurs on the mastoid bone behind the ears. This condition causes destruction of adjacent tissues and appears as a lump/knot under the skin and behind the ear. Cholesteatoma can also cause drainage in the ear, hearing loss and dizziness.

Lipoma-Lipoma is a benign mass of fatty tissue that forms under the skin, a bump or knot behind ear. The lipoma lump is made up of fat, which develops between the skin and subcutaneous tissue. A lipoma can occur anywhere on the body, including the area behind the ears. In majority of the cases, lipomas are harmless. As the lipomas grow larger, they can be felt quite easily with the hands.

Dermatofibromas2- Dermatofibromas are benign and harmless skin bump or knot that is rarely seen back of the ear. The bump is firm and hard to touch. Most skin growth are painless but causes itching in surrounding skin. The skin mass is also known as benign fibrous histiocytomas. The growth is caused by formation of multiple layer of epithelial cells and keratin over the original skin. Cause is not known.

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Keratoacanthoma3- The tumor mass originates in hair follicle. If ignored, then it turns into squamous cell carcinoma. The cell mass underneath the superficial layer of keratin multiplies and also deposits additional keratin over the superficial surface of epithelial cells. The swelling or bump on examination feels firm to hard in consistency. The surrounding skin become hypersensitive and marginally inflamed. Keratoacanthoma is rare behind the ear and more often grows on skin that is frequently exposed to sun. The bump often looks like squamous cell carcinoma.

Granulomas4- Granuloma is a collection of dead immune white blood cells known as macrophages. Granuloma occurs when macrophages surrounds local foreign body or sutures material left during surgery. Granuloma is also formed following recovery from skin infection and inflammation caused by bacteria and fungus. The bump or knot is hard in consistency. The benign growth is often painless but causes itching.

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Malignant Skin Cancer: Cause of Lump or Knot Behind Ear

Cancer can appear anywhere in the body. If it affects the salivary gland, then it can appear as a lump or a knot behind the ear. Skin cancer can also cause lumps or knots behind the ears. Malignant lumps tend to increase in size over the time.

Basal Cell Carcinoma5- The outer skin is formed by multiple layer of epithelial cells. The epithelial cells are frequently replaced as old cells die. The lowest layer of epithelial cell is known as basal cell. Basal cell multiplies in large number, when cell layer is activated by foreign body, viruses or consistent exposure to ultraviolet radiation of sunlight. The growth of basal cell appears as a bump behind the ear. Such growth is prevented when sun screen is used during exposure to sun. Bump looks pink or white waxy growth.

Squamous Cell Carcinoma6- The epithelial layer of skin is formed by basal cell and multiple layer of squamous cells. Multiple layer of squamous cells lie superficial to basal cells. Layer of squamous cell multiplies when skin is exposed to sun. The irritation caused by ultraviolet radiation of sun causes persistent growth of squamous cell epithelial cells. Such growth is known as squamous cell carcinoma. The cancer growth does not spread to distant organ and often completely cured once the tumor mass is surgically removed.

Melanoma7- Melanoma is a growth of melanin cells that lies within mole under the skin. Melanin cells multiples when exposed to sun. Melanoma is a common skin cancer and spreads into adjacent as well as distant tissue and organ. Such spread is known as metastasis. Melanoma is common among female under age 40. Melanoma is prevented by not exposing skin and mole to sun as well as regular use of sun screen lotion, when mole and skin is exposed to sun.

Diagnosis of Lump Behind Ear or Knot Behind Ear

The differential diagnosis of lump or knot behind ear involves clinical examination and lab study.

Clinical Examination- Clinical examination includes documentation of detailed history of bump or knot behind ear. Then the lump is carefully examined to differentiate infection and cancer.

Fever- If the patient suffering with lump or knot behind ear also suffers with fever then the cause is most likely skin infection, ear infection or mastoiditis. The bump is caused by enlarged lymph node when Individual is suffering with middle ear infection and mastoiditis.

Lump- If the lump or the knot feels soft, painless and pliable, then it can be a lipoma, Painful soft lump can be caused by carbuncle, furuncle or impetigo. Individuals with a history of acne can easily detect a lump or knot behind the ear, which appears as a pimple.

Tender and painful swelling that spreads within the subcutaneous tissue is caused by abscess.

Itching- The skin around the bump is often itchy and such condition is observed when bump is caused by adenocarcinoma, squamous cell carcinoma and melanoma.

Blood Examination-

White Blood Cell Count (WBC)- WBC count is high in patient suffering with furuncle, carbuncle and impetigo

Biopsy study- Biopsy involves removal of small piece of bump or growth. The sample of tissue is treated with several stains. The tissue sample taken from bump caused by infection shows inflammatory changes. Similarly, biopsy tissue sample shows basal cell, squamous cell or melanin cells cancer. The biopsy of lymph node shows either inflammatory changes or cancer cells.

Radiological Examination- Radiological studies include X-Ray, CT scan, MRI and ultrasound. These investigational studies are performed to diagnose middle ear infection and mastoiditis. The radiological studies of skin infection and cancer diseases may not show any positive signs.

Treatment for Lump Behind Ear or Knot Behind Ear

Conservative Treatment

  • Garlic oil + Olive oil ear drops for ear pain cause by mastoiditis.
  • Benzoyl peroxide and retinoid- Used to treat acne.

Pain Medication

  • NSAIDS (Non-steroidal anti-inflammatory medications): Motirnn Naproxen and Celebrex
  • Opioids- Vicodin and Oxycodone
  • Corticosteroids-Prednisone pills or local cortisone ointment is used for acne and itching
  • Antibiotics- Antibiotics for furuncle, carbuncle and impetigo. Most frequently used antibiotics are Oxacillin, Clindamycin and Cefazolin.
  • Chemotherapy- Basal and squamous cell carcinoma as well as melanoma.
  • Surgery- Surgery is performed to remove benign and malignant cancer. Most surgeries are performed in outpatient surgery under local anesthesia. Surgery is also performed to remove the pus from infected skin diseases that may have spread within subcutaneous tissue.
  • Treatment for lump behind ear or knot behind ear that is painless and benign is treated for cosmetic reason and often surgically removed.

When To See Your Physician for Lump or Knot Behind the Ear -

Prevention is always better than treatment of lesion which is advanced and may cause complication. You must see your physician if any family member has a skin disease such as boil and impetigo. If you see any growth which does not look like pimples and growing in size you must see your physician to rule out skin infection or cancer.

References-

  1. Common benign skin tumors.

    Luba MC1, Bangs SA, Mohler AM, Stulberg DL.,Am Fam Physician. 2003 Feb 15;67(4):729-38.

  2. Keratoacanthoma

    Patrick M. Zito; Richard Scharf., Last Update: February 21, 2019.

  3. Dermatofibroma

    David J. Myers; Eric P. Fillman., Last Update: February 15, 2019.

  4. Granulomatous skin disease with a histological pattern of palisading granuloma – an atypical facial necrobiosis lipoidica or more?

    Anna Rosińska-Więckowicz and Monika Bowszyc-Dmochowska, , Postepy Dermatol Alergol. 2017 Dec; 34(6): 618–621.

  5. Basal cell carcinoma

    C S M Wong, specialist registrar in dermatology,1 R C Strange, professor in clinical biochemistry,2 and J T Lear, consultant dermatologist1, BMJ. 2003 Oct 4; 327(7418): 794–798.

  6. Cutaneous squamous cell carcinoma.

    Garcia-Zuazaga J1, Olbricht SM.,Adv Dermatol. 2008;24:33-57.

  7. Malignant Melanoma: A Pictorial Review

    Collette McCourt,1 Olivia Dolan,1 and Gerry Gormley2, Ulster Med J. 2014 May; 83(2): 103–110.

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: April 15, 2019

This article does not provide medical advice. See disclaimer

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