Hello @pjdonn, not knowing is the worst but worry does not help anyone. Taking control and planning the next step is a positive approach. My tumor in the external ear canal invading into the temporal bone behind my ear was not easily diagnosed because it did not show up on scans. It was creating severe pain 24/7 which was hard to control. Yours is large enough to feel and cause painful pressure, but fine needle aspirates only remove cells that are along the needle tracks which may not pick up all parts of the mass. Firm tumors tend to not shed cells easily into the needle. A surgical biopsy may be a more accurate diagnostic method, if that is what they are recommending. Take the next step and stick with the diagnostics until you get an answer. Don't hesitate to ask for referral to a larger medical facility.