Enlarged Neck Lymph Nodes: Causes and Follow-Up Care

Improvement of cervical lymphadenopathy?

Hello Dr.
Zheng, I apologize for the disturbance.
Around early November 2019, I noticed a lymph node in my lower jaw triangle area that was about 1-1.5 cm in size on both sides, with the left side being larger.
On December 20, I went to Taipei Asia University Hospital for a neck ultrasound, where I was also found to have enlarged tonsils and throat discomfort.
During the ultrasound, a lymph node on the left side of the posterior triangle was noted to be about 0.8-1 cm in size.
The doctor ruled out malignancy, stating it was somewhat enlarged but only due to infection, and advised follow-up.
The doctor did not explain why this was happening, and I trusted the physician's expertise.
No medication was prescribed at that time, and I did not ask further questions.
However, over the past few weeks, my tonsils have improved, but the lymph nodes have not decreased in size; they definitely have not shrunk, and I don't think they have enlarged either.
Recently, I have been feeling very fatigued, and I wake up with significant shoulder and neck soreness.
I have quit smoking but have been using e-cigarettes.
Sometimes, I feel like my throat is phlegmy and I am losing my voice, and I often get canker sores, making me feel unwell overall.
I also have issues with autonomic nervous system dysregulation (I looked up the symptoms online).

Q1: I would like to ask the doctor if it is necessary to return for a follow-up regarding my lymph node issue.

Q2: I tend to stay up late, around two or three in the morning; could this be a reason for my lymph node enlargement?
Q3: My throat feels uncomfortable and phlegmy throughout the day, and by the evening, speaking feels difficult and phlegmy, though I wouldn't say it's hoarse.
Could this be due to the e-cigarettes?
Thank you for your answers, and I appreciate your hard work!

Ivan, 20~29 year old female. Ask Date: 2020/01/15

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
If you are concerned, you may return for a follow-up visit or ultrasound in 3-6 months.

2.
Lymphadenopathy is associated with immune system abnormalities, and chronic sleep deprivation may lead to chronic inflammation and enlargement of the lymph nodes.

3.
Chronic pharyngitis is related to smoking; quitting smoking is recommended for complete improvement.

Wishing you peace and health,
Dr.
Cheng Jue-Yi
Director, Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2020/01/15

More Info

Hello! Thank you for reaching out with your concerns regarding your enlarged neck lymph nodes and associated symptoms. Let's address your questions one by one, while also providing some context about lymphadenopathy and its implications.

Q1: Do I need to return for a follow-up regarding my lymph nodes?
Given your history of enlarged lymph nodes, particularly in the context of previous infections, it is advisable to have a follow-up appointment. While your doctor previously indicated that the enlargement was likely due to infection and not malignancy, persistent lymphadenopathy (enlarged lymph nodes) that does not resolve over time warrants further evaluation. This is especially true if you are experiencing additional symptoms such as fatigue, neck pain, or discomfort in your throat. A follow-up can help ensure that there are no underlying issues that need to be addressed, and it can provide peace of mind.

Q2: Could my late sleeping habits contribute to the enlargement of my lymph nodes?
While late-night sleeping habits alone are not directly linked to lymph node enlargement, they can contribute to overall health issues that may affect your immune system. Poor sleep can lead to increased stress and decreased immune function, which might make you more susceptible to infections. If your body is under stress or not getting adequate rest, it may struggle to recover from infections, potentially leading to prolonged lymphadenopathy. It’s essential to prioritize good sleep hygiene, as adequate rest is crucial for maintaining a healthy immune system.

Q3: Could my throat discomfort and phlegm be related to electronic cigarette use?
Yes, electronic cigarette use can contribute to throat irritation and discomfort. Vaping can lead to inflammation of the respiratory tract, which may manifest as a sensation of phlegm or a scratchy throat. The ingredients in e-liquids, including nicotine and various flavorings, can irritate the mucous membranes of the throat, leading to symptoms similar to what you are experiencing. If you notice that your throat discomfort worsens with vaping, it may be worth considering reducing or eliminating this habit.

Additional Considerations:
Lymph nodes are an essential part of the immune system, and they can become enlarged for various reasons, including infections, inflammation, or malignancy. In your case, the previous assessment suggested that the enlargement was likely due to a reactive process from an infection, which is common. However, if the lymph nodes remain enlarged or if you develop new symptoms, further investigation may be warranted.

Your symptoms of fatigue, neck pain, and throat discomfort could also be indicative of other underlying conditions, including chronic stress or anxiety, which you mentioned in relation to your autonomic nervous system dysregulation. Stress can exacerbate physical symptoms and lead to a cycle of discomfort and anxiety.

In summary, I recommend scheduling a follow-up appointment with your healthcare provider to reassess your lymph nodes and discuss your ongoing symptoms. Additionally, consider lifestyle modifications such as improving your sleep schedule, reducing electronic cigarette use, and managing stress to support your overall health. If you have any further questions or concerns, don’t hesitate to reach out to your healthcare provider. Your health and well-being are paramount, and it’s essential to stay proactive in addressing any issues that arise.

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