Exploring Further Tests for Chronic Throat Issues and Lymph Node Swelling

What other tests can be performed?

Two months ago, I suddenly experienced a sensation of something stuck in my throat, which an ENT specialist diagnosed as chronic pharyngitis, and it has not improved since.
Subsequently, I developed chest tightness along with a cough, which was diagnosed as bronchitis after a chest X-ray; I am no longer coughing now.
My menstrual period has also been absent for three weeks.
Three weeks ago, I noticed swelling in the lymph nodes on the right side of my face.
After taking antibiotics for a week, I developed symptoms of night sweats, but the lymph nodes have neither enlarged nor decreased in size, and they are not visibly noticeable.
A week ago, I started experiencing occasional neck pain, sharp pain in the back of my head, back pain, numbness in my right face, and warmth in my calves.
Today, I have developed pain near my nostrils that feels like pressing on a pimple, although there is no pimple present; it feels uncomfortable, as if it is coming from the root of my tooth.
I am increasingly concerned that I may have contracted a bacteria like tuberculosis that can spread throughout the body, but I do not have any sputum for testing.
I would like to ask the doctor: how large must a lymph node be to warrant a biopsy? Which specialty would be most appropriate for me to seek assistance? Thank you.

NIMI, 20~29 year old female. Ask Date: 2016/10/21

Dr. Ji Zhaoyun reply Otolaryngology

Hello NIMI, based on your description, the cervical lymph nodes can undergo ultrasound examination in the otolaryngology department.
If necessary, fine needle aspiration for cytological examination will be determined by the physician based on the ultrasound results, not solely on size.
Your symptoms are less typical; if you are concerned about an unknown infection, it is advisable to consider consulting an infectious disease specialist for further evaluation.
Wishing you peace and health.
Sincerely, Dr.
Chi Chao-Yun, Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/10/21

More Info

Your symptoms and concerns regarding chronic throat issues and lymph node swelling are indeed complex and warrant a thorough evaluation. Based on the information you've provided, it appears that you have been experiencing a series of interconnected health issues, including chronic pharyngitis, bronchitis, lymphadenopathy, and various systemic symptoms such as night sweats, pain, and facial discomfort.

Understanding Your Symptoms
1. Chronic Pharyngitis and Bronchitis: Chronic throat issues can often be attributed to various factors, including allergies, infections, or irritants. The diagnosis of chronic pharyngitis suggests ongoing inflammation, which could be due to persistent irritants or infections. The bronchitis you experienced, which has since resolved, may have been a secondary issue related to your throat condition.

2. Lymphadenopathy: The swelling of lymph nodes, particularly in the right facial area, can be a response to infection or inflammation. Lymph nodes can become enlarged due to various causes, including viral infections, bacterial infections, or even autoimmune conditions. The fact that your lymph nodes have not significantly changed in size after antibiotic treatment suggests that the underlying cause may not be bacterial.

3. Systemic Symptoms: The night sweats, neck pain, and other systemic symptoms you describe could indicate a more generalized response to an underlying condition. These symptoms can be associated with infections, autoimmune diseases, or even malignancies.

When to Consider Further Testing
In terms of lymph node size and the necessity for a biopsy, there are general guidelines. Typically, lymph nodes larger than 1 cm in diameter, especially if they are persistent, hard, or associated with systemic symptoms (like fever, night sweats, or unexplained weight loss), may warrant further investigation, including a fine needle aspiration (FNA) or excisional biopsy. Given your symptoms and the duration of lymphadenopathy, it may be prudent to discuss this with your healthcare provider.

Recommended Specialists
Given the complexity of your symptoms, it would be advisable to consult with a few specialists:
- Otolaryngologist (ENT Specialist): Since you have chronic throat issues, an ENT specialist can provide a comprehensive evaluation of your throat and neck, including any necessary imaging studies or endoscopic examinations.

- Infectious Disease Specialist: If there is a concern about a systemic infection (such as tuberculosis or other bacterial infections), an infectious disease specialist can help evaluate and manage these conditions.

- Rheumatologist: If autoimmune conditions are suspected, particularly given your systemic symptoms and lymphadenopathy, a rheumatologist can perform further evaluations and tests to rule out conditions like lupus or Sjögren's syndrome.

Conclusion
In summary, your symptoms are concerning and suggest that further evaluation is necessary. It is important to communicate openly with your healthcare providers about all your symptoms and concerns. They can guide you through the appropriate tests and referrals to ensure a comprehensive approach to your health issues. Early intervention and accurate diagnosis are key to managing your symptoms effectively. Please ensure you follow up with your healthcare provider to discuss these options and any further testing that may be necessary.

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