What is the symptomatic treatment for a painful lump behind the left ear?

Management of Painful Lump Behind Left Ear

For a painful lump behind the left ear, the first-line treatment is a combination of analgesics for pain relief and topical antimicrobial/anti-inflammatory therapy if infection is present. The approach depends on the underlying cause, with auricular perichondritis being a common consideration.

Differential Diagnosis

Before treatment, consider these common causes:

• Auricular perichondritis/perichondrial abscess: Presents as painful swelling, warmth, and redness that often spares the earlobe 1
• Infected sebaceous cyst or furunculosis: Localized infection of hair follicle in the ear canal 1
• Lymphadenopathy: Enlarged lymph node due to infection elsewhere
• Contact dermatitis: Common with nickel exposure from earrings 1
• Otitis externa: Inflammation of the ear canal 1

Treatment Algorithm

1. Pain Management

• For mild to moderate pain: Acetaminophen or NSAIDs (ibuprofen 400mg every 4-6 hours as needed) 2, 3
• For severe pain: Consider NSAIDs plus opioid combination with fixed interval dosing 2
• Topical analgesics: May provide additional brief benefit for ear pain 1

2. If Infection Is Suspected (redness, warmth, swelling)

• For auricular perichondritis:

  • Fluoroquinolone antibiotics (ciprofloxacin or levofloxacin) are first-line treatment 1
  • If abscess is present, surgical incision and drainage may be necessary 1

• For otitis externa:

  • Topical antimicrobial/corticosteroid combination therapy (e.g., ciprofloxacin 0.3%/dexamethasone 0.1% otic suspension) 2
  • Do not prescribe systemic antimicrobials unless there is extension outside the ear canal or specific host factors 1
  • Keep the ear dry during treatment 2

3. For Contact Dermatitis

• Remove the sensitizing agent (e.g., nickel earrings) 1
• Apply topical corticosteroids or calcineurin inhibitors (tacrolimus 0.1% ointment or pimecrolimus 1% cream) 1

Special Considerations

• For embedded earrings: May require gentle probing or small incision under local anesthesia 1
• For torn earlobes: Clean and repair within 12-24 hours 1
• For recurrent issues: Avoid reinserting earrings until 6-8 weeks after resolution of swelling and tenderness 1

Red Flags Requiring Further Evaluation

• Age >50 years, smoking history, alcohol use, diabetes mellitus, or immunocompromised status 4, 5
• Symptoms persisting beyond 7 days despite appropriate treatment 1
• Ear drainage continuing for more than 7 days 2

Patient Education

• Avoid inserting anything into the ear canal, including cotton-tipped swabs 2
• Limit use of antibiotic eardrops to no more than 10 days to prevent yeast infections 2
• For those with pierced ears, consider removing jewelry at bedtime to prevent pressure sores 1
• Use longer earring posts with adjustable backings if embedding is a problem 1

Remember that proper diagnosis is essential for effective treatment, and if symptoms persist despite appropriate therapy, further evaluation may be necessary.