Swollen Lymph Nodes: Causes, Concerns, and Next Steps

Cervical lymphadenopathy

Hello Doctor: I have noticed swollen lymph nodes on both sides of my neck near the jawline.
They are not visible on the surface, but I can feel them when I lower my chin.
Initially, there was tenderness, and they are movable, with a smooth and oval shape.
After seeing a doctor, I was told it was lymphadenitis, and I was prescribed medication.
Subsequently, the swelling has decreased, and the tenderness has lessened.
I had an ultrasound, which showed one lymph node measuring about 0.8 cm and another about 0.9 cm.
I also underwent a nasopharyngoscopy and a thyroid ultrasound, both of which showed no abnormalities.
The doctor mentioned that the likelihood of it being benign is high and advised me to observe for three months before having a follow-up ultrasound.
It has been about three weeks now, but occasionally I experience a dull, tingling pain from my jaw to my ear.
I previously mentioned this to my doctor, who said it might be due to inflammation.
I would like to ask the doctor: 1.
Is it a concern that the lymphadenopathy (which has slightly decreased) has not resolved after three weeks? I have been pressing on it frequently due to worry; could this have an impact? 2.
Why do I sometimes feel a dull, tingling pain from my jaw to my ear? Is this a normal reaction, or could there be another cause? It has been some time, and I have also taken antibiotics and other medications for treatment.
3.
Is there a possibility that this could be lymphoma or a malignant tumor? I would appreciate it if the doctor could clarify my concerns and provide some answers to ease my worries.

Fanrao de ren, 30~39 year old female. Ask Date: 2020/06/15

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
There are many lymph nodes present in the neck, and after an infection improves, the lymph nodes may not completely disappear to the point of being undetectable.
Currently, all examinations show no significant abnormalities, and it is recommended to observe for three months before performing a follow-up ultrasound.

2.
The sensation of tingling and pain may be caused not only by inflammation but also by poor posture, muscle tension, excessive rubbing, or anxiety.

3.
It is difficult to determine, so regular follow-up is advised.
If there are concerns, the clinician may perform a biopsy or aspiration for further examination.

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

Reply Date: 2020/06/15

More Info

Swollen lymph nodes can be a source of concern for many patients, especially when they are accompanied by symptoms such as pain or discomfort. In your case, you have described swollen lymph nodes located in the submandibular area, which have shown some improvement but have not completely resolved after three weeks. Let's address your questions one by one.

1. Persistence of Swollen Lymph Nodes: It's not uncommon for lymph nodes to remain swollen for some time after an infection or inflammatory process. Lymph nodes can take weeks to months to return to their normal size, especially if they were significantly enlarged due to an infection. The fact that you have noticed a reduction in size is a positive sign, indicating that the inflammation is resolving. However, frequent palpation or pressing on the lymph nodes can sometimes cause irritation or prolong the swelling, so it's advisable to minimize unnecessary manipulation.

2. Pain and Discomfort: The occasional pain or tingling sensation from your jaw to your ear could be attributed to several factors. It may be related to the inflammation of the lymph nodes themselves, which can cause discomfort in surrounding tissues. Additionally, the proximity of the lymph nodes to the muscles and nerves in that area means that inflammation can lead to referred pain. If the pain persists or worsens, it may be worth discussing further with your physician, as they may want to evaluate for other potential causes, such as temporomandibular joint (TMJ) dysfunction or dental issues.

3. Concerns About Lymphoma or Malignancy: The likelihood of your swollen lymph nodes being due to lymphoma or another malignancy is generally low, especially given the characteristics you've described (smooth, movable, and reduced tenderness). The fact that imaging studies such as ultrasound and endoscopy have not revealed any abnormalities further supports the benign nature of your condition. Lymphoma typically presents with more concerning features, such as persistent enlargement, hard consistency, and associated systemic symptoms (fever, night sweats, weight loss). However, if you have ongoing concerns, it is always reasonable to seek a second opinion or request further evaluation, such as a biopsy, if warranted.

In summary, while swollen lymph nodes can be alarming, they often indicate a benign process, particularly following an infection. It is essential to follow your doctor's advice regarding monitoring and to return for follow-up imaging as recommended. If you experience any new symptoms or significant changes, do not hesitate to reach out to your healthcare provider for further evaluation. Remember, your health and peace of mind are paramount, and addressing your concerns with your physician is the best course of action.

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