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Enlarged Lymph Nodes Behind Ear
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cooknratedotcom posted:
My 2 & 1/2 year old son has an enlarged lymph node (about the size of a small pea) behind his left ear (above the cavity behind the ear lobe, sitting somewhat on the bottom edge of the skull bone behind the ear). The node on the same location behind the right ear is also enlarged but only to about the size of a grain of sand (barely noticeable). We first noticed these node enlargements last year about a week after he received a round of immunizations shots. We took him to his paediatrician and she assured us that it was not a health concern at all since the enlargements were isolated (i.e. not all nodes in the body) and very small. Her suspicion was that there was a scratch or similar cause of inflamation somewhere that triggered the enlargement. The only thing we could think of was that the little guy was sucking his thumb too much (left thumb) and had perforated the skin on the back of the thumb, but the doctor didn't think there was a link to that. She had a sonograph done to conform the enlargement was not a cyst.

A few monthts later the enlargements remained the same (not getting bigger and not getting smaller). We had a follow up appointment but the doctor again said the enlargements were too small to be a concern. As it turned out, we had also noticed that the skull bone behind the child's let ear is bigger than the corresponding one behind the right ear. We discussed this with his paediatrician also. She concurred that with us that the left side of the base of the skull was indeed bigger. She brought in a colleague from the next door office for a neutral opinion. They both assured us that this was normal assymetry of the skull.

Since then there has been no change in this situation (over a year now). The little guy is otherwise very healthy and has not symptoms of ill health. He has seasonal allergies occasionally, is teething normally and still sucks his thumb to the point of breaking the skill every now and then.

My questions are:

Have you encountered this kind of situation?

Is it normal for lymph nodes to enlarge and not return back to original size (which should be completely invisible behind the ear)?

Is there any link between these events (lymph node enlargement, assymetry of left and right skull base bones, vaccinations, teething, allergies, thumb sucking)?

The paediatrician said not to be concerned, but should I really not be concerned? (I admit, I have a tendency to worry a little more than I should, like most parents perhaps).

Thank you. I appreciate your support.
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Rod_Moser_PA_PhD responded:
You are a normal parent....it is normal for you to worry about these things, but your pediatrician is telling you straight. Lymph node enlargements in a two-year old are VERY common...some kids even feel like a bag of marbles when you examine them.

Lymph nodes in this area can enlarge for many, many reasons -- various infections, colds, allergies, dental problems, skin disorders (insect bites, dryness, etc.), cat scratches, etc. Once a node becomes enlarged in reaction to inflammation or infection, it can stay enlarged for some times....even years. As long as they do not increase in size, become painful, hard, irregularly shaped, or proliferate all over the place, they are usually innocent. Vaccinations or thumb-sucking would not cause lymph node reactions around the skull or neck.

I don't have the ability to comment on the skull asymmetry -- I would have to examine your son first-hand, so you are going to need to trust your doctors on this one, too.

Parents worry...they worry about cancers, lymphomas, leukemia, etc. This is normal. This is why you need to have a good medical provider that you trust...and one that listens to your concerns. I can't give you the reassurance you need over the Internet, but I believe your pediatricians have your son's best interest at heart. You can always see a good ENT for a second opinion if you want....


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