Brief Answer: Inflammed lymph nodes always have swelling of node Detailed Answer: Hello, Thanks for posting on XXXXXXX If you feel pain around the mastoid area without swelling, then lymph node inflammation may not be the most likely culprit. We need to look at diseases conditions such as mastoiditis, otitis/ear infection, abscess, temporomandibular joint dysfunction (TMJ) etc. Mastoiditis being the most likely cause followed by otitis or ear infection. Mastoiditis is bacterial infection of the mastoid bone. You will require pain killers and a course of antibiotics prescribed by a doctor after evaluating you. Also, if lymph nodes are present (palpable), then it could still be reaction due to inflamed mastoid bone. You may require ENT consultation if problem persist despite receiving antiinflammatory pain killers and antibiotics. Hope this helps and wish you the best. Dr. Nsah

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