[18F] With lump behind ear, peeling tongue, and dental issues

Patient Description

An 18-year-old female reports a hard, pea-sized lump behind her left ear that appeared suddenly. It is painful when pressed but otherwise does not cause pain and has not changed in size. She also experiences peeling skin on her tongue intermittently for a few weeks without relief. Additionally, she has had night sweats, fatigue, and a change in appetite but no difficulty swallowing. She has a cracked tooth on the right side causing significant pain, though there is no swelling or redness. Ear pain occurs when touching the ear canal or when water enters the ear, along with some hearing changes. The patient vapes daily and has done so for four years. Family history includes heart attacks, heart disease, diabetes, and cervical cancer. She is on birth control and does not have a menstrual cycle. She takes medication for depression nightly but is unsure of the name and dosage. No other medications, supplements, or herbal remedies are taken.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Lump Behind the Ear

  • Lymphadenopathy: This is a condition where the lymph nodes become swollen, often due to an infection or inflammation. Given that the lump is hard and painful when pressed, it could be a swollen lymph node.
  • Sebaceous Cyst: These are non-cancerous, closed pockets of tissue that can be filled with fluid, pus, or other material. They are usually painless unless infected.
  • Mastoiditis: This is an infection of the mastoid bone, which is located behind the ear. It can cause swelling and pain, especially if you have had recent ear infections.

Peeling Tongue

  • Geographic Tongue: This is a condition where parts of the tongue are missing layers of papillae, giving it a map-like appearance. It is usually harmless but can cause discomfort.
  • Nutritional Deficiencies: Deficiencies in vitamins such as B12, iron, or folic acid can cause changes in the tongue's appearance.
  • Oral Thrush: This is a fungal infection that can cause white patches and peeling on the tongue.

Night Sweats, Fatigue, and Appetite Changes

  • Infections: Conditions like tuberculosis or other systemic infections can cause night sweats and fatigue.
  • Hormonal Imbalances: Thyroid issues or other hormonal imbalances can lead to these symptoms.
  • Depression or Anxiety: These mental health conditions can also manifest physically, causing changes in appetite, fatigue, and night sweats.

Tooth Pain and Ear Pain

  • Dental Abscess: A cracked tooth can lead to an abscess, which is a pocket of pus caused by a bacterial infection. This can cause severe pain and may affect the ear.
  • Ear Infection: Pain when touching the ear canal or when water gets in the ear could indicate an ear infection.

What you can do

Lump Behind the Ear

  • See a Doctor: It's important to get this lump evaluated by a healthcare professional to rule out any serious conditions.
  • Avoid Pressing: Try not to press on the lump to avoid further irritation.

Peeling Tongue

  • Maintain Oral Hygiene: Brush your teeth and tongue regularly and use an antiseptic mouthwash.
  • Stay Hydrated: Drink plenty of water to keep your mouth moist.
  • Consult a Dentist: A dental professional can help diagnose and treat any underlying issues.

Night Sweats, Fatigue, and Appetite Changes

  • Consult a Healthcare Provider: These symptoms can be indicative of various conditions that need medical evaluation.
  • Maintain a Healthy Diet: Ensure you are eating a balanced diet rich in vitamins and minerals.
  • Track Symptoms: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

Tooth Pain and Ear Pain

  • See a Dentist: Immediate dental care is essential for a cracked tooth to prevent infection.
  • Avoid Irritants: Try to keep water out of your ear and avoid touching the ear canal.
  • Pain Relief: Over-the-counter pain relievers like ibuprofen can help manage pain temporarily.

What you should look out for

Given the severity and variety of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Fever or Chills: These could indicate an infection.
  • Severe Pain: Especially if it becomes unbearable or spreads.
  • Swelling or Redness: Around the lump, tooth, or ear.
  • Difficulty Breathing or Swallowing: These are emergency symptoms.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.

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3 mo ago


People Also Ask


What could cause a hard, painful lump behind the ear?

A hard, painful lump behind the ear could be due to lymphadenopathy, which is swelling of the lymph nodes often caused by infection or inflammation. Other possibilities include a sebaceous cyst or mastoiditis, an infection of the mastoid bone.


Why might my tongue be peeling intermittently?

Peeling of the tongue can be caused by geographic tongue, which is usually harmless, nutritional deficiencies such as a lack of B12 or iron, or oral thrush, a fungal infection.


What are common causes of night sweats and fatigue in young adults?

Night sweats and fatigue in young adults can be caused by infections, hormonal imbalances like thyroid issues, or mental health conditions such as depression or anxiety.


How can a cracked tooth lead to ear pain?

A cracked tooth can lead to a dental abscess, which is a bacterial infection that can cause severe pain and may affect the ear. Additionally, an ear infection could cause pain when touching the ear canal or when water enters the ear.

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