<s>[INST] When I look in my 4 yr olds ear with an otoscope he has a black hair like object. Its texture looks like a stitch. What would that be? For at least six months now he has had swollen glands and lymph nodes throughout his neck, is there any connection between the two? [/INST] Hello, A child with swelling in the neck suggests of lymphadenopathy or lymph node swelling.  Does he have a fever, significant weight loss? Does he have any other complaints like hearing loss on that side of the ear? He needs a few investigations of the blood like total and differential counts and the lymph nodes need to be evaluated by both general physical exam and probably a lymph node biopsy.  The black mass in the ear needs to be examined by an horoscope and removed by an ENT Surgeon.  Hope I have answered your query. Let me know if I can assist you further. Take care Chat Doctor.  </s>