Lumps, Nodules and Cysts Around the Ears

Lump, cysts and nodules can form around the ear for various reasons. Some of these causes may include congenital defects like preauricular sinuses, or acquired conditions like sebaceous cysts, lipoma or enlarged lymph nodes. These lumps can come in different shapes, sizes, textures, and may be tender to touch or completely painless.

Generally, most of them are harmless and do not require medical attention. However, some people may want to remove them for various reasons:

• Complications such as infection, and development of malignant tissue
• Pre-emptive removal of the lump to prevent the above complications
• Purely aesthetic reasons.

If a lump or cyst is there for a short period of time and disappears spontaneously, then usually there is nothing to worry about.  The commonest cause of these are acne cysts and minor skin infections.  In these cases, different cyst removal treatment procedures are employed.

Types of lumps around the ear

Lumps and nodules around the ear may be similar in appearance, but most of them are distinct histologically and have different causes. It is important to understand these different types of ear lumps before undergoing treatment.

In general, lumps around the are most commonly one of the following 3 conditions.

• Sebaceous, trichilemmal/pilar or epidermoid cysts

A cyst is a lump which contains a fluid inside.  When touched, you can feel like there is a “bubble” beneath the skin.  There are different types of cysts around the ear.  When used in the broader sense, the term sebaceous cyst is commonly used to refer to any of the 3 types of keratin/sebum filled cyst found directly under the skin. These are epidermoid cysts, trichilemmal/pilar cysts and true sebaceous cysts respectively. These cysts are usually smooth to the touch, rounded and may occasionally be tender to touch. They are most commonly found on the face, especially around the ears and on the scalp, but may occur anywhere on the body except the palms and the soles of the feet.

Sebaceous cysts are formed when keratin or sebum are trapped in a shell of tissue under the skin. Epidermal tissue can become implanted in the dermis from trauma, injury, disease, or blocked pores adjacent to a body piercing. The embedded epidermal tissue continues to secrete keratin or sebum, which becomes trapped under the skin, forming the cyst.

Although all 3 types of sebaceous cysts form similarly, they are histologically distinct as described below:

• Epidermoid cyst: This consists of a shell of epithelial cells (protective cells in the skin) with a keratin core.
• Trichilemmal/pilar cyst: This has a keratin core similar to an epidermoid cyst, but the shell is derived from the outer root sheath of a hair follicle instead of epithelial cells. Hence, this cyst is mostly found along the hairline near the ears, around the sideburns.
• True sebaceous cyst: Unlike the other 2, a true sebaceous cyst has a sebum core, instead of keratin. It is also much rarer compared to the other 2.

To the patient, the differentiation is not so important because the treatment for epidermoid cysts, trichilemmal cysts and sebaceous cysts is almost the same.  Removal is a simple affair that can usually be done under local anesthesia, with excellent cosmetic results after healing.  An experienced surgeon will be able to limit the size of the incision, ensuring the smallest scar possible.

• Preauricular sinuses and complications

A preauricular sinus is common congenital defect found on the ears. It appears as a skin-lined nodule, lump, depression, or pit found in front of the anterior root of the helix. It is usually caused by improper development of the outer ear in the foetus, but no exact cause has been determined.

Alone by itself, a preauricular sinus is largely harmless. However, they can become infected or form cysts, which may cause swelling, pain and discomfort, among other complications. In these cases, pus can collect in the sinus and will need to be drained occasionally. In serious cases, surgical intervention may be required.

Preauricular sinuses can get infected repeatedly and cause on and off inflammation, pain, pus and swelling.  As such, preauricular sinuses are usually confused with recurrent pimples or cystic acne.  However to an experienced surgeon, the diagnosis is easily made from the history and physical examination.

Removal of preauricular sinuses requires careful surgical exploration to elucidate the path of the sinus and complete removal of the sinus tract, and is a minor surgery.

• Lipoma

A lipoma is a benign tumour made of adipose/fat tissue. It is usually described as a soft lump under the skin which is movable, and generally painless. Lipomas are the most common non-cancerous soft-tissue tumour, occurring in about 2% of all people. They can be easily diagnosed via a physical or histological examination.

The exact cause of lipoma is unclear, but it is commonly associated with certain risk factors. These include heredity, obesity and lack of exercise. They also occur more often in males compared to females.

Lipomas are generally harmless and can be left alone. However, in rare cases, they may develop into liposarcoma, a cancer originating from fat tissue. It is also possible for an early stage liposarcoma to be mistaken for a harmless lipoma without careful examination.

Lipomas are sometimes confused with lymph nodes and need detailed physical examination to elucidate the cause of it.

• Lymph nodes

The area around the ears has a number of lymph nodes and these can enlarge with recent infections of the throat, skin, scalp or ears.  The usual description of these lymph nodes is a small “seed” measuring 1-2 cm or less, which moves easily under the skin.  These are usually also slightly painful to the touch if they are caused by recent infections and will disappear by themselves over time.  Lymph nodes that do not disappear, grow bigger and harder and especially those which are not painful, may be a sign of something more sinister, like cancer.  These need to be investigated further with ultrasound, and possibly removed to exclude cancerous changes.

Nevertheless, the above list is not exhaustive and you lump may not fall into any of these types. It is always important to consult medical professional as they can provide you with the most accurate diagnoses.

Treatment

Most lumps and nodules on or around the ears are harmless, and can generally be left alone. However, there is indeed some risk of them developing complications, such as serious infection or becoming malignant. In these cases, these lumps can be surgically removed.

The surgeon will generally remove any cystic tissue or tumour via an incision. The operated area is then disinfected and the incision is closed. In rare case, a small skin graft may be needed to cover the operated area. These surgeries are carried out under local or general anaesthesia.

Also, depending on the type of lump and its underlying cause, different follow-up actions may be required after surgical excision.

Although most lumps around the ear are benign in nature, it is advised to get them examined as there is still a chance of them being malignant. Even if the lump is benign, you may also remove them as a preventive measure, or simply for aesthetic reasons