Swollen Lymph Node Behind Ear

My three-year-old son has had a swollen lymph node behind his right ear for three months. I asked his pediatrician for a CBC and was denied. I called again a month later saying the node had not changed, again requesting a CBC. I was told to take him to his ENT. (My son had tubes placed almost two years ago for chronic otitis media. Both are now out.) My son's voice is hoarse. It comes and goes, almost sounds like he is in puberty. He has an appointment at the end of the month. Should I push for a CBC before that?


Lymph nodes, as you know, swell in response to infection. What's really happening is that white blood cells within the lymph node are dividing madly to make more antibody to fight the infection. Think of a toy factory gearing up production for the Christmas rush, and you'll have the correct concept. However, unlike the toy factory after Christmas, when the infection is over, this factory has a bit of difficulty changing gears for the slow season.


Some lymph nodes "melt" away after the resolution of an infection, while others remain enlarged for weeks, months, even decades. As long as the node does not exhibit slow growth (which would raise my suspicions for some other sort of tumor), it is safe to watch it.


I'm puzzled by your insistence on a CBC (complete blood count). CBCs do yield a good quantity of information -- for example, whether your child is anemic, or whether there is an active infection present. Unless you have a specific question, however, the data contained in a CBC (or any other clinical test) are meaningless. You might think that the white blood cell count would be useful, since if it is elevated this would suggest the presence of an active infection. Yet "active infection" is definitely something that your son's pediatrician should be able to determine through a careful history and physical. If your child's physical exam is unremarkable (except for the enlarged lymph node), an elevated white blood cell count is not going to shed much light on the problem.


Your son is intermittently hoarse, he has an enlarged lymph node and he has a history of recurrent ear infections or persistent middle ear fluid. ("Chronic otitis media" is defined as a chronic, nonhealing perforation of the eardrum; this would not be treated with ventilation tubes.) These are all problems that fall under the domain of your son's ear, nose and throat doctor (ENT). Your son's hoarseness and enlarged lymph node could be signs of a potentially dangerous problem; this is very unlikely, but certainly not impossible. His ENT should be able to intelligently examine him to discern if one of these rare problems is present.


by Douglas Hoffman