Persistent Swollen Lymph Nodes: When to See an ENT or Infectious Disease Specialist? - Otolaryngology

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Persistent swollen lymph nodes can be a concerning symptom, especially when they do not improve with initial treatment. In your case, you have a history of a cat bite, which could potentially be related to the lymphadenopathy (swollen lymph nodes) you are experiencing. It is important to consider the possibility of an infection, particularly one that may be associated with the bite, such as cat scratch fever (caused by Bartonella henselae) or other bacterial infections.

Given that you have already seen an ENT specialist and have been on medication for three weeks without improvement, it may be time to consider further evaluation. The persistent swelling and the development of a third lymph node suggest that there may be an underlying issue that needs to be addressed.
In terms of which specialist to see, both an ENT (Ear, Nose, and Throat) specialist and an infectious disease specialist can provide valuable insights. An ENT specialist is well-equipped to evaluate head and neck issues, including lymph nodes, and can perform necessary examinations or imaging studies. However, if there is a suspicion of an infectious process that is not responding to standard treatment, an infectious disease specialist may be more appropriate. They can conduct further testing, such as blood tests or cultures, to identify any underlying infections and recommend targeted treatments.

Here are some additional considerations and steps you might take:
1. Follow-Up Appointment: Schedule a follow-up appointment with your ENT specialist to discuss the lack of improvement and the new lymph node. They may recommend imaging studies, such as an ultrasound or CT scan, to assess the lymph nodes further.

2. Consider Infectious Disease Consultation: If your ENT specialist feels that the swelling may be due to an infectious process, they may refer you to an infectious disease specialist. This specialist can provide a more comprehensive evaluation and may suggest additional tests, such as serologies for specific infections or even a biopsy if warranted.

3. Monitor Symptoms: Keep track of any additional symptoms you may experience, such as fever, night sweats, weight loss, or changes in your overall health. These symptoms can provide important clues to your healthcare provider about the underlying cause of your lymphadenopathy.

4. Discuss Treatment Options: If an infection is confirmed, the treatment may involve antibiotics or other medications. If the lymph nodes are swollen due to another cause, such as an autoimmune condition or malignancy, the treatment approach will differ significantly.

5. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another ENT or infectious disease specialist can be beneficial.

In conclusion, given the persistence of your symptoms and the recent development of additional swollen lymph nodes, it is advisable to pursue further evaluation. You may choose to see either an ENT or an infectious disease specialist, depending on your symptoms and the recommendations of your current healthcare provider. It is crucial to address this issue promptly to ensure appropriate diagnosis and treatment.