Neck Masses: Symptoms, Diagnosis, and Next Steps

Neck mass

Hello Dr.
Chi,
I discovered post-nasal drip four weeks ago, which lasted for a week before stopping.
I noticed a lump in the left side of my neck, under the jaw, in the area of the internal jugular lymph nodes.
Initially, it was painless, but during this time, I consulted three different otolaryngologists, and they examined my nasal cavity three times, all stating that my nasopharynx and nasal cavity were normal.
However, in the last ten days, I have started experiencing tinnitus, and the neck lump has been growing larger, now reaching about three centimeters.
I am also feeling intermittent pain.
I went back to see another otolaryngologist, who again said everything was normal.

I am currently in Germany and feel very confused, as all three local otolaryngologists have told me that everything is fine, but I believe my symptoms are very similar to those of nasopharyngeal cancer.
I am very worried and insisted to the local doctors that I need to investigate the cause of the neck swelling.
Eventually, the doctor suggested that I pay out of pocket for an MRI to examine the neck swelling and nasopharynx.

I would like to ask Dr.
Chi what method of examination would be appropriate for my situation: ultrasound, CT, or MRI? I feel that the doctors here may not be very sensitive to the symptoms of nasopharyngeal cancer, possibly because it is a rare condition among Europeans.
I have been worried for a month, and after seeing three otolaryngologists, they all said there was nothing wrong with the large lump in my neck and did not prescribe any medication.
The last doctor advised me to take a medication called Ibuprofen; is that appropriate?
Thank you very much for your help, Dr.
Chi.

Mi Wang Nu, 20~29 year old female. Ask Date: 2019/02/02

Dr. Ji Zhaoyun reply Otolaryngology

Hello, according to your description, nasopharyngeal carcinoma is typically diagnosed through nasopharyngeal endoscopy, and if necessary, a biopsy of the nasopharyngeal mass may be performed.
However, if the neck tumor continues to progress and does not respond to antibiotics, a computed tomography (CT) scan can be considered for further evaluation.
Wishing you peace and good health.
Sincerely, Dr.
Chi Chao-Yun, Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2019/02/02

More Info

Hello! Thank you for reaching out with your concerns regarding the neck mass and associated symptoms. Based on your description, it sounds like you have been experiencing a series of troubling symptoms, including post-nasal drip, a growing neck mass, ear ringing, and pain. It's understandable to feel anxious, especially when you suspect a serious condition like nasopharyngeal cancer.

Symptoms and Initial Evaluation
The symptoms you've described—post-nasal drip, a palpable mass in the neck, and ear symptoms—can be associated with various conditions, ranging from benign to malignant. The fact that the mass has increased in size and is now painful is particularly concerning and warrants further investigation.

Diagnostic Imaging Options
When it comes to evaluating neck masses, there are several imaging modalities available, each with its own advantages:
1. Ultrasound: This is often the first-line imaging study for evaluating neck masses, especially in children and young adults. It is non-invasive, does not involve radiation, and can provide information about the size, shape, and characteristics of the mass. However, it may not provide a complete picture of deeper structures.

2. CT Scan: A CT scan of the neck can provide detailed cross-sectional images and is particularly useful for assessing the extent of a mass, its relationship to surrounding structures, and for detecting any lymph node involvement. It is often used in cases where malignancy is suspected.

3. MRI: MRI is excellent for soft tissue evaluation and can provide detailed images of the neck structures. It is particularly useful for assessing the brain and spinal cord, but it can also be used for neck masses. However, it is generally more expensive and less accessible than CT.

Given your symptoms and the increasing size of the mass, a CT scan or MRI would likely be the most appropriate next steps. These imaging modalities can help clarify the nature of the mass and guide further management.

Next Steps
Since you have already seen multiple ENT specialists, it is crucial to advocate for yourself. If you feel that your concerns are not being taken seriously, consider seeking a second opinion from a different specialist or a multidisciplinary team that includes oncologists.

Pain Management
Regarding the medication you mentioned, Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that can help alleviate pain and reduce inflammation. It is generally safe for short-term use, but it is essential to follow the dosage instructions and consult with a healthcare provider if you have any underlying health conditions or are taking other medications.

Conclusion
In summary, your symptoms warrant further investigation, and a CT scan or MRI would be appropriate next steps to evaluate the neck mass. It is essential to communicate your concerns clearly to your healthcare providers and ensure that you receive the necessary evaluations. If you continue to feel that your concerns are not being addressed, do not hesitate to seek out additional opinions. Your health and peace of mind are paramount.
Please take care, and I hope you find the answers and relief you need soon!

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