Small bumps on neck and behind ears

Finding a lump on the area of skin behind your ear can cause anxiety. Fortunately, lumps and bumps are usually completely harmless and easily treatable.

Dr Roger Henderson looks at the possible causes for lumps behind your ear, any treatments that may be needed, and when to seek medical advice:

What causes a lump behind the ear?

There are many possible reasons why you may notice a lump behind an ear, including the following:

1. Cysts

Skin cysts are small, fluid-filled sacs that can occur anywhere on the skin and are often caused by blocked skin glands. One of the commonest types are called sebaceous cysts which are often seen on the head, neck and back. These arise from blocked sebaceous glands that produce the oily secretions that lubricate the skin. These are harmless but can occasionally become infected when they can be red, painful and increase in size. Skin cysts are typically mobile and so can be moved from side to side.

2. Acne

Acne is a very common skin condition, particularly in younger people. In this condition, pores and follicles in the skin become blocked with oil and dead skin which forms a layer called a comedone. This can cause a lump on the skin which can become infected and inflamed, including behind the ear.

3. Lipomas

Lipomas are completely harmless fatty lumps that develop under the skin and which may occur anywhere on the body. If these are very small they may not be felt but if larger you can feel them as a small, soft and mobile lump that is usually painless. They range in size from pea-size to an inch or two in diameter. Compared to a skin cyst, lipomas are usually found deeper in the skin and feel much softer.

Enlarged lymph glands are one of the most common reasons for a lump developing behind the ear.

4. Skin abscesses

When cells or body tissues become infected, the body’s natural defences send white cells to that area to help fight off the infection. This can lead to a build-up of fluid as well as swelling of the area. If the white cells accumulate then pus can start to develop, which is a mix of white cells, bacteria, and tissue. If this continues then an abscess may form which is painful, warm, tender to the touch and may sometimes discharge yellowish pus.

5. Enlarged lymph glands

Enlarged lymph glands are one of the most common reasons for a lump developing behind the ear and is a reaction the body being exposed to potential infection from bacteria and viruses. The lymph nodes behind the ear are called the posterior auricular lymph nodes and if they swell up these are usually felt as small painless pea-sized lumps behind the ear. They should be painless and go back to a normal size within 2-3 weeks, usually being triggered by a skin or ear infection in that area (such as otitis media).

6. Mastoiditis

Mastoiditis is a serious ear infection occurs and does not get treated effectively, then the infection may affect the part of the skull bone behind the ear called the mastoid, causing the problem known as mastoiditis. This type of infection is more common in children than adults but is a serious problem requiring medical attention with antibiotics and sometimes assessment by an ear, nose and throat (ENT) specialist. It can cause pus-filled cysts to develop behind the affected ear which are felt as lumps.

How do I know what type of lump it is?

If the lump is soft, painless and moves around when you touch it then it is likely to be a lipoma or a simple skin cyst. If it is painful to the touch, or tender generally it may be an abscess or infected spot or cyst. If other symptoms are present such as a high temperature, headache or feeling generally unwell then an infection is likely.

When should I see a doctor?

Although the majority of lumps behind the ear are completely harmless and will settle over a few weeks with no treatment, seek medical advice if the following occurs:

• The lump remains unchanged after 2-3 weeks
• The lump is painful or discharging
• The lump appears very suddenly
• The lump increases in size or shape
• The lump does not move or feels ‘fixed’ behind the ear
• Other symptoms are present such as a temperature, feeling unwell or weight loss.

Your doctor will usually diagnose the lump by a simple examination and prescribe treatment such as antibiotics if necessary. Occasionally a lump may require further investigation and a sample may be taken from it (a biopsy) or imaging tests such as X-rays and MRI scans may be undertaken.

A lump behind the ear is usually harmless and easy to treat, and it isn't always the sign of a serious or long-term problem. That's typically the case with swollen lymph nodes, infections, and skin conditions that lead to lumps behind the ear.

Less often, tumors can form behind the ear. These tumors may be benign, as with a mastoid osteoma, or they may be cancerous, as in cases of parotid (salivary) gland cancers.In some cases, they may begin as small, soft spots but become large and harder as they grow.

This article discusses the common symptoms and possible causes of a lump behind the ear. It will help you to know when you should see a healthcare provider and what some of the treatment options are.

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Causes of a Lump Behind the Ear

A lump behind the ear can form for several reasons. The most common causes of a lump in this spot are infections and skin conditions. Less frequently, tumors can develop here.

A lump behind the ear can develop anywhere between the top of the ear down to the lobe. Depending in part on the cause, these small- to medium-sized bumps may feel soft or hard.

A lump might be tender or painful. Some lumps do not cause any discomfort.

Common Infections

You might notice a lump behind your ear when you get sick. If you catch strep throat or an ear infection, the lymph nodes behind your ears can become swollen and inflamed.

Other common infections can also cause swollen lymph nodes, such as:

• Abscessed or impacted teeth
• Gum disease
• Influenza or other upper respiratory infections
• Lyme disease (an illness caused by a bacterium carried by ticks)
• Mononucleosis (an infection caused by a herpes virus)
• Oral herpes (an infection of the herpes simplex virus)
• Sexually transmitted infections (STIs)
• Tonsillitis (inflammation of the tonsils in the back of the throat)

Lyme Disease

Serious Infections

Skin infections can also cause lymph node swelling. In some cases, infected skin can lead to a growth called an abscess, which looks like a large pimple.

Mastoiditis, a bacterial infection affecting the mastoid bone behind the ear, can also cause a lump. This condition usually results from an untreated middle ear infection that spreads to the mastoid bone.

Other symptoms of mastoiditis include:

• Ear drainage
• Ear pain
• Fever
• Headache
• Redness around the ear
• Trouble hearing

Keloids

You may experience a lump behind the ear after piercing that doesn't go away. It's not common, but these lumps, called keloids, happen in about 2.5% of ear piercing cases.

Essentially, these are scars that grow beyond the site of a piercing or wound. They can be difficult to treat, as keloids have a tendency to grow back even after they're surgically removed.

Acne

Acne is a common skin condition that produces pimples, often due to hormonal changes. Acne can appear in many parts of the body, but the face is the most common site. Pimples can also develop behind the ears.

Over-the-counter (OTC) acne creams and face washes may help treat mild acne. More severe acne may require prescription-strength medication. A pimple can also become infected. Try not to scratch or touch pimples to reduce the chances of infection.

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Lipomas

Lipomas are a type of skin growth. The fatty lumps of tissue are not hard and can be moved around under the skin. They can form in various parts of the body, including behind the ears.

Lipomas are harmless but can cause discomfort. You usually do not need to treat a lipoma unless it is bothering you. In this case, you can have it removed.

Cysts

Cysts are made up of dead skin cells and oils. They will feel soft to the touch and often go away on their own. 

Cysts are not usually painful unless they become infected. If this happens, antibiotics may be necessary. If a cyst causes discomfort or is likely to cause problems because of where it is located, it might need to be removed.

Benign or Malignant Tumors

A lump behind the ear can be a harmless (benign) or cancerous (malignant) tumor.

For example, it's not common for a lump behind the ear to be associated with lymphoma, and most lumps caused by nasopharyngeal cancers are found toward the back of the neck even though other ear symptoms may be involved.

But if you have a lump behind your ear and your healthcare provider wants to rule out cancer, they will usually need to perform a biopsy, a procedure that involves removing a sample of tissue to examine it more closely.

Bumps that are cancerous have several characteristics that make them different from harmless, more common lumps. Malignant lumps are more likely to:

• Be fixed in place
• Be uneven or irregular in shape
• Feel hard

Pain and discomfort are not necessarily indicators of a cancerous tumor. Some lumps that are harmless can hurt, while some malignant lumps do not cause any pain.

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When to See a Healthcare Provider

If you find a lump behind your ear, you might be wondering if you need to seek medical attention for it. While most lumps behind your ear are not serious, there are some cases for which you should have a healthcare provider take a look.

You should make an appointment if the lump behind your ear:

• Appears out of nowhere
• Is accompanied by other symptoms
• Is painful or causes discomfort 

Your healthcare provider will first do a simple examination. They will ask you questions about the lump—such as when you first noticed it—to figure out what is causing it.

Sometimes, the lump behind your ear will be a swollen lymph node. If this is the case, you should see a healthcare provider if:

• It is swollen, red, and painful.
• It feels hard.
• If it gets bigger or does not reduce in size after several weeks.
• You have other unexplained symptoms such as fever, night sweats, or weight loss.

If you have swollen lymph nodes with these other symptoms, your healthcare provider may wish to perform some blood tests, a biopsy, or a computed tomography (CT) scan to help make the correct diagnosis.

Treatment

Most infections that cause a lump behind the ear will go away on their own. For example, a mild ear infection that causes swollen lymph nodes may resolve on its own. However, bacterial infections will require antibiotic treatment. 

Some skin conditions that can cause lumps behind the ears are easily treated with OTC or prescription medications. Other skin lumps, like cysts or lipomas, might need to be removed.

In the case of tumors, treatment depends on whether the tumor is benign or malignant. In most cases, surgery will be required to remove the tumor. The bigger the tumor, the more complex the surgery will be.

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Summary

A lump behind the ear can have several possible causes. Most of the time, the cause is something that is not serious and that will get better on its own or with minimal treatment.

However, if the lump hurts, gets bigger, or is accompanied by other symptoms, it should be checked out by a medical professional.

In rare cases, tumors can form behind the ear and require complex treatment. If you have a lump behind your ear and other symptoms, particularly if they show up suddenly, it's important to tell your healthcare provider. They can diagnose the cause and decide on the best course of treatment.

Frequently Asked Questions

• Should I be worried about a lump behind my ear?

  In most cases, small lumps are nothing to worry about, but you should keep an eye on a sudden lump. If you have other symptoms such as fever, or if the lump grows or feels hard like a marble, you should see a healthcare provider.

  Learn More: When Should You Be Concerned About a Fever?

• Are there lymph nodes behind the ear?

  Yes. Known as the posterior auricular lymph nodes, these can become swollen if you have an ear infection. German measles, also known as rubella, causes these lymph nodes to swell as well.

  Learn More: Purpose of the Lymph Nodes

• Can you get a lump behind your ear from glasses?

  Yes. Eyeglass frames that don't fit well may irritate the skin and lead to cysts or other lumps. One type of nodule, called acanthoma fissuratum, can affect the nose and ears because of the persistent irritation. See your healthcare provider about these lumps in order to rule out skin cancer.

  Why do I have bumps on my neck and behind my ears?

  Lumps behind the ear can often be caused by colds, the flu, strep throat or respiratory infections. That's because an infection can cause the lymph nodes behind your ears to become swollen and inflamed. Most of the time, swollen glands are not a cause for concern.

  Why do I feel tiny bumps on my neck?

  The most common cause of neck lumps are that your lymph nodes are swollen. This commonly occurs when your body is fighting an infection, such as the flu, mono, or strep throat. As the infection clears up, your swollen lymph nodes should go back to their normal size.

  Why do I have a bumpy rash behind my ear?

  A rash behind the ear may occur due to a variety of different medical conditions. Certain viral infections and autoimmune diseases may cause a rash behind the ear in both children and adults. While some causes, such as contact dermatitis, are not concerning, other causes, including rubella, may be more serious.

  Are small bumps on your neck normal?

  The good news is that neck lumps are common and most often harmless. They can come in different sizes and textures, and they're usually non-cancerous. But there are a few types of lumps that could be a sign of a more serious condition, and you can't detect these through simple home evaluations.