Lump Behind the Ear: Causes, What It Feels Like and When to Worry

01Area

What is behind the ear

The area behind the ear contains skin with hair follicles and oil glands, a small group of lymph nodes (the posterior auricular nodes) and, under the skin, the mastoid bone, a bony bump that everyone can feel just behind the ear lobe. Further down, near the angle of the jaw, are the lower part of the parotid salivary gland and more lymph nodes of the neck. A new lump usually comes from one of these structures, and its position, texture and associated symptoms point to the cause.

Feel both sides: the mastoid bone is hard, symmetrical and does not move. A new soft or rubbery lump on only one side is more likely to be a node, cyst or spot.

02Causes

Common causes of a lump behind the ear

• Swollen lymph node: the most common cause. Nodes react to scalp infections, dandruff or eczema of the scalp, ear infections, throat infections, colds, insect bites, piercings and viral illnesses such as glandular fever or rubella.
• Epidermoid or sebaceous cyst: a smooth, round, slow-growing lump under the skin, sometimes with a small dark opening. It can become red and painful if infected.
• Spot, boil or abscess: a red, tender lump that may form a yellow or white head. Boils are infected hair follicles. For spots inside the ear, see pimple in ear.
• Lipoma: a soft, doughy, painless lump of fatty tissue that moves easily and grows very slowly.
• Mastoiditis: an infection of the mastoid bone, usually after a middle ear infection. It causes redness, swelling and tenderness behind the ear, sometimes pushing the ear forward, with fever and ear pain.
• Keloid: a firm, raised scar, often after an ear piercing or injury.
• Less common: salivary gland lumps, other benign tumours and, rarely, lymphoma or cancer spreading to lymph nodes.

03Compare

How to tell the causes apart

• Soft or rubbery, tender, appeared with a cold or sore throat: a reactive lymph node is most likely.
• Smooth, round, slowly growing, with a tiny central pore: a skin cyst.
• Red, hot, painful, with a head: a spot, boil or infected cyst.
• Very soft, doughy and painless for months: probably a lipoma.
• Painful red swelling behind the ear with fever and an ear infection: possible mastoiditis; seek urgent care.
• Hard, fixed, painless and growing over weeks: needs prompt medical assessment.

Pain behind the ear without a lump has other causes, such as jaw joint problems or nerve irritation; see our guide to pain behind the ear.

04Lymph nodes

Swollen lymph nodes behind the ear

Lymph nodes are part of the immune system and filter fluid from nearby tissues. When the scalp, outer ear or throat is infected or inflamed, the nodes behind the ear can enlarge to the size of a pea or a small bean and feel tender. They usually go down within two to three weeks once the infection settles. Treating the cause, for example scalp dermatitis, head lice, an infected piercing or a throat infection, helps them shrink.

Nodes deserve a medical check if they are larger than about two centimetres, hard, fixed to surrounding tissue, growing, present for more than three weeks without an obvious cause, or appear with fever, night sweats, unexplained weight loss or swollen glands elsewhere in the body. Related throat causes are covered in swollen tonsils.

05Home care

What you can do at home

• Watch the lump for two to three weeks and note whether it grows, shrinks or changes.
• Apply a warm compress for 10 minutes a few times a day to a tender spot or boil.
• Do not squeeze, pierce or try to drain a lump; this can spread infection.
• Treat scalp problems such as dandruff, eczema or head lice.
• Keep piercings and the skin behind the ear clean and dry.
• Use simple painkillers if the area is sore and they are suitable for you.

06Assessment

How doctors find the cause

A doctor asks how long the lump has been there, whether it has changed and what other symptoms you have, then examines the lump, the ear, the scalp, the throat and the rest of the neck. Often this is enough to make a diagnosis. If the cause is unclear or the lump persists, an ultrasound scan can show whether it is a node, a cyst or a fatty lump. Blood tests can look for infections such as glandular fever. A fine-needle sample or a small biopsy is taken when a node or lump looks suspicious. For mastoiditis, an urgent examination of the ear and sometimes a scan are needed.

07Treatment

Treatment depends on the cause

• Reactive lymph nodes: no specific treatment; they settle when the infection clears.
• Infected spot or boil: warm compresses; antibiotics or drainage by a doctor if it is large or spreading.
• Cyst: can be left alone if small and painless; removed with a minor procedure if it becomes infected repeatedly or bothers you.
• Lipoma: usually left alone; removed if it grows or is uncomfortable.
• Mastoiditis: urgent antibiotics, often in hospital, and sometimes surgery.
• Suspicious lump: referral to an ENT or head and neck specialist.

08Children

Lumps behind the ear in children

Children often have small, soft, movable lymph nodes behind the ears and in the neck, especially after colds, throat infections or scalp conditions. These are usually normal. Seek urgent medical help if a child has an ear infection and develops redness, swelling or tenderness behind the ear, the ear starts to stick out, or the child has a high fever, is very unwell or has discharge from the ear. These can be signs of mastoiditis. Ear infections in younger children are covered in ear infection in babies.

09Summary

Key points to remember

• Most lumps behind the ear are lymph nodes, cysts or spots.
• Reactive nodes are soft, mobile and settle within two to three weeks.
• A red, painful swelling behind the ear with fever and an ear infection needs urgent care.
• Hard, fixed, growing or persistent lumps should be checked.