What are the treatment options for a 16-month-old child with a bump on their ear?

Evaluation and Management of a Bump on the Ear in a 16-Month-Old

A bump on the ear in a 16-month-old requires immediate clinical examination to determine if it represents a congenital deformity, infection, trauma-related injury, or mass lesion—each requiring distinct management approaches.

Initial Clinical Assessment

The first priority is determining the exact nature and location of the bump through focused examination:

• External ear inspection: Assess whether the bump involves the pinna (outer ear cartilage), earlobe, or ear canal opening 1
• Signs of infection: Look for erythema, warmth, tenderness, purulent drainage, or fever that would indicate infectious etiology 2
• Trauma history: Ask about recent ear piercing, foreign object insertion, or blunt trauma 3, 4
• Congenital features: Determine if this is a longstanding deformity versus acute onset 1

Management Based on Specific Diagnoses

If Infectious (Cellulitis, Abscess, or Perichondritis)

For localized infection with purulent drainage:

• Topical ciprofloxacin or ciprofloxacin-dexamethasone drops twice daily for 7-10 days is the preferred treatment 5, 2
• Systemic antibiotics are unnecessary unless the child appears systemically ill or infection extends beyond the ear 2
• Clean any drainage with cotton swabs dipped in hydrogen peroxide or warm water 5

For severe infection or perichondritis:

• Refer urgently to pediatric otolaryngology for potential surgical drainage and systemic antibiotics 5

If Congenital Deformity or Malformation

• Ear deformations (distorted but present anatomical structures) in infants under 8 weeks can be corrected with nonsurgical ear molding/splinting 1
• At 16 months of age, this window has closed—surgical correction is the only option if cosmetically significant 1
• Ear malformations (absent anatomical structures) uniformly require surgical reconstruction and will not self-resolve 1
• Refer to pediatric plastic surgery or pediatric otolaryngology for evaluation and surgical planning 5

If Trauma-Related

For minor abrasions or hematoma:

• Minor bleeding from ear canal trauma typically resolves spontaneously without intervention 6
• Parents should not insert cotton swabs or objects into the ear canal 6
• Antibiotic drops are NOT routinely needed unless signs of infection develop 6

For suspected middle ear trauma:

• High-resolution CT of temporal bone is indicated if there is concern for ossicular damage, facial nerve injury, or perilymphatic fistula 3
• Refer to pediatric otolaryngology for specialized evaluation 5

If Embedded Earring

• This occurs most commonly in children under 10 years, with the posterior portion typically embedded in the earlobe 4
• Removal requires local anesthesia in most cases; procedural sedation is rarely needed 4
• 35% have concurrent infection requiring topical or systemic antibiotics 4
• This supports delaying ear piercing until the child can perform self-care 4

If Mass Lesion

• Rare tumors such as hamartomas can present as middle ear masses in infants and young children 7
• CT imaging is essential for diagnosis and surgical planning 7
• Refer to pediatric otolaryngology for biopsy and definitive management 5

Red Flags Requiring Urgent Referral

Refer immediately to pediatric otolaryngology if any of the following are present:

• Rapidly expanding mass or significant swelling 5
• Facial nerve weakness or other cranial nerve deficits 3
• Persistent purulent drainage beyond 7 days despite treatment 5, 2
• Suspected perilymphatic fistula (vertigo, progressive hearing loss) 3
• Systemic signs of severe infection (high fever, toxicity) 2

Common Pitfalls to Avoid

• Do not assume all ear bumps are benign: While most are self-limited, missing a serious infection or rare tumor can lead to significant morbidity 7
• Do not delay referral for congenital deformities: By 16 months, nonsurgical correction is no longer possible, and families should be counseled early about surgical options 1
• Do not prescribe oral antibiotics reflexively: Topical therapy is superior for localized ear infections, with cure rates of 77-96% versus 30-67% for oral antibiotics 5
• Do not insert objects to remove debris: This can worsen trauma and introduce infection 6