Differential Diagnosis

The following differential diagnosis is based on the symptoms described:

• Single most likely diagnosis:
  • Lymph node: The description of a hard, grape-sized lump under the earlobe that is not attached to the skin and has been unchanged for over a year could suggest a lymph node. The fact that it feels smooth and can be differentiated from the surrounding tissue also supports this diagnosis.
• Other Likely diagnoses:
  • Salivary gland stone or tumor: The location under the earlobe and the fact that the lump is more palpable in certain positions, such as when the mouth is closed, could suggest a salivary gland issue.
  • Cyst or abscess: Although the lump has been unchanged for a long time, it's possible that it could be a cyst or an abscess that has become chronic.
  • Cartilaginous or fibrous nodule: The hard, smooth texture of the lump could also suggest a cartilaginous or fibrous nodule.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Parotid gland tumor: Although less likely, a tumor of the parotid gland could present as a hard lump under the earlobe. Given the potential for malignancy, this diagnosis should not be missed.
  • Metastatic lymph node: In rare cases, a lymph node in this location could be a sign of metastatic cancer from another site.
• Rare diagnoses:
  • Branchial cleft cyst: A congenital anomaly that could present as a lump under the earlobe, although typically these are more superficial and present earlier in life.
  • Eagle syndrome: A rare condition where an elongated styloid process or calcified stylohyoid ligament causes a lump or pain in the neck, although this typically presents with more symptoms such as pain or dysphagia.