Complex ENT Symptoms: Pain, Swelling, and Systemic Issues

Right-sided sore throat, sensation of a foreign body in the right side of the throat, stiffness at the right neck base, right cheek pain, right ear pain, pain around the right eye socket, right-sided migraine, swollen and painful lymph nodes under the chin, swollen and painful lymph nodes behind the ear with itching, and gingivitis with bleeding gums?

I have been experiencing symptoms for over two months, including pain in the right throat, a sensation of a foreign body when swallowing on the right side, stiffness at the base of the right neck, pain in the right cheek, pain in the right ear, pain around the right eye, right-sided migraines, and painful swelling of the lymph nodes in the chin area.
Additionally, I have swollen and painful lymph nodes behind the ear that are itchy, along with gingivitis causing bleeding gums.
Systemically, I have gastroesophageal reflux (chest pain, back pain, bloating), and I am prone to red spots on my body that can be itchy.
I also experience mild night sweats once or twice a week, swollen lymph nodes in the lower lumbar region (0.3 cm on the left and 1 cm on the right), lower back pain, and yellowish urine.
I have a history of mild asthma and cervical spine pain.
Hello, doctor.
I would like to seek your opinion regarding my overall condition.
At the end of November, I noticed multiple swollen lymph nodes in my neck, with two on the left side in front of the ear (about 1.5 cm each), one on the right side of the chin (1.5 cm), and one in the middle of the right neck (0.5 cm).
Initially, there was only mild tenderness.
After consulting a traditional Chinese medicine practitioner, I was told it might be due to tuberculosis.
After taking herbal medicine, the lymph nodes behind both ears began to itch and hurt, with tenderness.
The nerves around the ears and neck also became itchy.
At the same time, my right eyelid started to feel heavy and dry, with pain around the eye socket.
When severe, closing my eyes felt like pressure on my eyeball, but I could still open them with effort.
I also experienced facial numbness (a tingling sensation), especially on the right side, which was more pronounced when lying down to sleep.
Additionally, when inhaling through my right nostril, I felt pain inside my right eye and above the gums on the right side.
This condition persisted for over a week, and I began to notice a sensation of a foreign body when swallowing on the right side of my throat.
Eventually, I discovered blood in my saliva upon waking up, and on the worst day, I vomited deep red material resembling blood clots.
I immediately consulted an ENT specialist, who performed a nasopharyngoscopy, X-rays, and tested for EBV.
The doctor informed me that there was swelling in the nasopharynx but no foreign body, and the X-ray showed increased opacity in the right maxillary sinus, possibly due to sinusitis.
I was prescribed antibiotics and anti-inflammatory medication for about ten days.
During this time, I also visited the hospital, where the doctor decided to perform a biopsy on the more prominent lymph node on the left side, and the report indicated a normal reactive hyperplasia.
After completing the ENT medication, I have since stopped taking it.
While the heaviness of my eyelid and facial numbness have improved (though still present), I no longer have blood in my saliva upon waking.
However, other issues have not worsened but have not improved either.
New symptoms have emerged, including painful swelling of the lymph node in the right chin area (not significantly swollen, but the skin feels hot and painful), and the sensation of a foreign body in my throat has intensified (especially on the right side).
Swelling of the lymph nodes in the lower lumbar region (0.3 cm on the left and 1 cm on the right) has also occurred, along with some lower back pain.
Systemically, I have started to develop red rashes that come and go, which can be itchy but some resolve after a while.
Occasionally, I experience mild night sweats.
During a follow-up visit to the hospital, the doctor mentioned that I had gum swelling (though I did not feel much discomfort), and advised me to see a dentist as soon as possible.
However, before I could see the dentist, I experienced bleeding from the upper right gums for over three minutes one day, along with gum pain.
In recent days, my urine has also become yellowish; drinking more water helps dilute it, but it is not as clear as it used to be.
Most concerning is that I have developed severe gastroesophageal reflux over the past two weeks, with symptoms of chest tightness, back pain, and bloating.
Interestingly, I have not experienced any fever throughout this time.
Since my symptoms began with ENT issues, I chose to consult you first.
I am unsure what might be causing these multiple systemic symptoms.
Which specialty should I consult next? (I am hesitant to take any more medications...)

roy, 30~39 year old female. Ask Date: 2020/02/01

Dr. Zheng Jueyi reply Otolaryngology

Hello, if the lymph node biopsy results are normal, it is recommended to first visit a dentist and then a general internist or a hematology-oncology specialist for further evaluation.
Wishing you peace and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/02/01

More Info

Based on the symptoms you've described, it appears that you are experiencing a complex interplay of ENT (ear, nose, and throat) issues along with systemic symptoms that may be interconnected. Your symptoms include right-sided throat pain, a sensation of a foreign body in the throat, cervical lymphadenopathy (swollen lymph nodes), facial pain, ear pain, headaches, and gastrointestinal issues such as acid reflux. Additionally, you mentioned experiencing skin rashes, night sweats, and changes in urine color, which further complicate your clinical picture.

Understanding Your Symptoms
1. ENT Symptoms: The right-sided throat pain and sensation of a foreign body could be indicative of several conditions, including:
- Tonsillitis or Pharyngitis: Inflammation of the tonsils or throat can cause pain and difficulty swallowing.

- Lymphadenopathy: Swollen lymph nodes in the neck can occur due to infections, inflammatory conditions, or malignancies. The fact that you had a biopsy that showed reactive hyperplasia is reassuring, but it still warrants monitoring.

- Sinusitis: The X-ray findings of increased opacity in the right maxillary sinus suggest sinusitis, which can lead to referred pain in the face, ear, and throat.

2. Systemic Symptoms: The presence of gastrointestinal symptoms like acid reflux, along with systemic signs such as night sweats and skin rashes, could suggest:
- Gastroesophageal Reflux Disease (GERD): This condition can cause chest pain and discomfort, especially if exacerbated by certain medications or dietary choices.

- Infectious or Inflammatory Conditions: Conditions like viral infections (e.g., Epstein-Barr virus, which you tested for) can present with systemic symptoms, including fatigue, lymphadenopathy, and gastrointestinal disturbances.

3. Neurological Symptoms: The heaviness of the eyelids and facial numbness could be related to nerve irritation or inflammation, possibly due to the underlying ENT issues or a separate neurological condition.

Recommendations for Further Evaluation
Given the complexity of your symptoms, it would be prudent to take a multidisciplinary approach to your care:
1. Otolaryngology (ENT): Since your symptoms began in the throat and ear regions, a follow-up with an ENT specialist is essential. They may consider further imaging studies, such as a CT scan of the sinuses, to evaluate for chronic sinusitis or other structural issues.

2. Gastroenterology: Given your gastrointestinal symptoms, a consultation with a gastroenterologist may be beneficial. They can assess for GERD and other potential gastrointestinal disorders that could be contributing to your symptoms.

3. Infectious Disease: If there is concern about an infectious process (especially given the lymphadenopathy and systemic symptoms), an infectious disease specialist may provide insights into whether further testing or treatment is necessary.

4. Allergy/Immunology: If you are experiencing skin rashes and other allergic symptoms, an evaluation by an allergist may help identify any underlying allergic reactions or sensitivities.

5. Primary Care Provider: Regular follow-ups with your primary care physician are crucial to manage your overall health and coordinate care among specialists.

Conclusion
Your symptoms are multifaceted and may stem from a combination of ENT issues, systemic inflammatory responses, and possibly gastrointestinal problems. It is essential to approach this situation holistically, ensuring that all potential underlying causes are explored. Keeping a detailed symptom diary, including any triggers or patterns you notice, can be helpful for your healthcare providers in diagnosing and managing your condition effectively. Please ensure you communicate openly with your healthcare team about all your symptoms and concerns, as this will aid in developing a comprehensive treatment plan tailored to your needs.

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