Lymph Node Swelling and Nasopharyngitis Symptoms

Is there a possibility of developing nasopharyngeal carcinoma?

Hello Doctor: In December, I noticed swelling of about three lymph nodes on the right side of my neck (they are palpable, with one being larger, approximately 1.5 cm, located in the upper neck).
After an ultrasound, the doctor said there was no major concern and that I should just monitor it.
However, I felt uneasy because online research indicated that swollen lymph nodes could point to nasopharyngeal cancer.
I began consulting with ENT specialists; many doctors examined my throat and nasal passages and prescribed expectorants.
Eventually, I found a clinic that used a small mirror to examine my nasopharynx, and the doctor said he did not see any tumors.
A week or two later, I went to a large hospital because I noticed blood in my nasal discharge.
The doctor used a nasopharyngoscope and said there were no polyps or tumors.
I felt much relieved.

However, one night I woke up in pain while swallowing saliva and felt a feverish sensation, thinking it was just due to wearing too many clothes.
Half-awake, I checked the swollen lymph nodes and found they had enlarged significantly, and I had developed another one.
Currently, I have six lymph nodes in my neck of varying sizes, all movable, which startled me.
I took my temperature and found it was 38.5°C, indicating I had a fever, which rose to 39°C after getting out of bed.
Both COVID-19 and influenza tests were negative.
As soon as the hospital opened, I went to see a doctor.
One doctor examined me and diagnosed me with sinusitis, prescribing antibiotics (Noclozine 625 mg) along with anti-inflammatory and gastric medications.
Since I was feeling unwell with the fever, I decided to visit another clinic in the afternoon for antipyretics.
The clinic doctor examined me and diagnosed me with purulent tonsillitis, also prescribing antibiotics and antipyretics.

After returning home, I took the medication and used a flashlight to look at my throat, discovering that the pus (or phlegm?) was stuck in the walls of my throat (there were gaps behind the uvula on both sides, but they were hard to notice).
It was very thick and seemed to be slowly dripping down from above, and the tonsils also appeared a bit whitish.
The differing opinions from the two doctors left me confused about my condition.
What should I do regarding the medications? The next day, I sought a third doctor for another opinion.
The doctor drew blood and noted that my blood cell counts were on the borderline, with elevated inflammatory markers.
He then used a nasopharyngeal endoscope and found a significant amount of yellow pus in the nasopharynx.
The doctor remarked that my nasopharynx was very dirty! He also checked the throat down to the vocal cords and noted redness and inflammation in that area.
Later, the doctor informed me that this was classified as nasopharyngitis and adjusted my medication, but I still needed to take antibiotics for seven days.

I would like to ask the doctor: 1.
Is the enlargement and increase in my lymph nodes related to the fever and infection? 2.
Is the thick yellow phlegm or pus in the nasopharynx really rare? I found that nasopharyngitis is common, but I do not have symptoms like mine.
I do not have a runny nose; sometimes I wake up with slight nasal congestion, but it clears up after standing.
Even when I feel a bit of moisture and blow my nose, it is clear mucus.
I wonder where that thick yellow substance is coming from? 3.
Can I proceed with the seven-day medication prescribed by the third doctor (Mucolytic cough syrup, Noclozine film-coated tablets, and Ipratropium)? Or should I finish the three-day medication prescribed by the clinic doctor first (Curam 1000 mg)? Do you have any recommendations on which doctor's medication I should prioritize? 4.
Are the nasopharyngeal areas seen through both nostrils the same place or different? Thank you for your assistance!

Douzi, 30~39 year old female. Ask Date: 2024/02/01

Dr. Ji Zhaoyun reply Otolaryngology

Hello,
1.
My lymph nodes have become larger and more numerous.
Is this related to fever and infection? > Based on the description, this is a very likely cause.
2.
Is thick yellow phlegm or pus in the nasopharynx really rare? I researched nasopharyngitis and found it to be quite common, but I don't have symptoms like mine.
I don't have a runny nose; sometimes I wake up with slight nasal congestion, but it clears up when I stand up.
Even when I feel a bit of wetness and blow my nose, it's just clear mucus.
I'm unsure where that thick yellow substance is coming from.
> Pus can be present in the nasopharynx, tonsils, and base of the tongue; it is common and may not necessarily be expelled by the individual.
3.
Can I start taking the seven-day medication prescribed by the third doctor? (Meizhi Kang cough suppressant and expectorant, Nocain coated tablets, and Ipratropium) Or should I finish the three-day medication prescribed by the clinic doctor first? (Curam 1000mg) Are there any other medications you would recommend from the doctors? > Medication questions should be directed to the physician who conducted the in-person consultation.
4.
Are the nasopharyngeal areas seen through both nostrils the same place or different? > There is only one nasopharynx, and it can be accessed from either the left or right nostril.

Reply Date: 2024/02/01

More Info

Hello! Thank you for sharing your detailed medical history and concerns regarding your lymph node swelling and nasopharyngitis symptoms. It seems like you have been through a lot in terms of seeking medical advice and treatment. Let's address your questions one by one.

1. Lymph Node Swelling and Fever: Yes, the enlargement of your lymph nodes is indeed related to your infection and fever. Lymph nodes are part of the immune system and often swell in response to infections, whether they are viral or bacterial. When your body detects an infection, it sends white blood cells to the affected area, causing the lymph nodes to swell as they work to fight off the infection. In your case, the presence of fever (38.5°C to 39°C) indicates that your body is actively fighting an infection, which is consistent with the swelling of your lymph nodes.

2. Thick Yellow Mucus or Pus: The thick yellow mucus or pus you are experiencing in your nasopharynx is not uncommon in cases of nasopharyngitis or sinusitis. While you may not have typical symptoms like a runny nose, the presence of thick mucus can occur due to inflammation and infection in the nasal passages and throat. The yellow color often indicates that your body is fighting an infection, as the color comes from white blood cells and other cellular debris. It’s important to note that while nasal congestion and runny nose are common symptoms, not everyone experiences them in the same way.

3. Medication Management: Regarding your medication, it is crucial to follow your healthcare provider's instructions. If your third doctor has prescribed a new course of antibiotics for seven days, it is generally advisable to complete that course as directed, especially if they have assessed your condition and believe it requires a different treatment approach. However, if you have already started the three-day course of antibiotics from the second doctor, you should consult with your healthcare provider about whether to continue that treatment or switch to the new prescription. It’s essential to avoid overlapping antibiotics unless specifically directed by a physician, as this can lead to complications or antibiotic resistance.

4. Anatomy of the Nasopharynx: The nasopharynx is a single anatomical area located behind the nose and above the soft palate. When you look into both nostrils, you are viewing the same nasopharyngeal space from different angles. Any inflammation or infection in this area can affect both sides, which is why you may notice symptoms in both nostrils.

In summary, your symptoms of lymph node swelling, fever, and thick mucus are likely interconnected and indicative of an infection, possibly nasopharyngitis or sinusitis. It’s essential to follow your healthcare provider's recommendations regarding medication and to keep them informed of any changes in your symptoms. If your symptoms persist or worsen, further evaluation may be necessary to rule out other conditions.

Please continue to monitor your symptoms closely, stay hydrated, and rest as much as possible. If you have any further questions or concerns, don’t hesitate to reach out to your healthcare provider for personalized advice. Wishing you a speedy recovery!

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