What causes constant sore throat and swollen lymph nodes?

Question

Hello doctor,

About two months ago, I developed a sore throat. It was mainly on the right side. I went to urgent care, and they did a quick strep test, which came back as positive. I also had a little bit of a stuffy nose, and mainly the right ear felt full or plugged. I went home with antibiotics, and after like four days, it seemed to be subsiding. Then on about the eighth day of the pills, it started to come back. By the time the antibiotics were gone, it was back. I went to urgent care, and again they did an actual culture that you grow in a dish. It was negative for strep, so they said it was a virus. My throat was still red, and the ear was congested. Then I waited. It would seem to get better and then would come back. Every time it came back, it hurt worse. It might be gone for a day or two or twelve hours. I started having a tickle in my throats and a cough. About eight days ago, it came back in a big way. I never ran a fever at all, which makes it seem weird. A few of the glands on my neck seem larger. There is phlegm coming from somewhere, and I cannot tell if it is from the sinuses or not. I always have to clear my throat. There is now some sinus involvement, as my cheekbones are aching. My voice feels scratchy. It does not hurt more to speak or eat, but it is annoying to do both, as it all feels tired and raw. I hate to make a big deal out of nothing, but looking things up online is telling me it could be bad. Can you give me any insight?

Answer 1

Hi,

Welcome to icliniq.com.

The symptoms described by you suggest that you are suffering from recurrent acute rhinopharyngitis. You may call it a recurrent acute upper respiratory tract infection. The initial infection has not healed completely, and it gets flared up frequently. Moreover, the infection has spread into the sinuses, ears, and lower airways. That produces headaches, constant post-nasal drip, tickle in the throat, cough, and phlegm. Due to a long-standing infection or recurrent infection, the lymph nodes draining the area have gotten swollen up after absorbing the offending agent. We must do some blood investigations and a culture sensitivity of the phlegm.

Meanwhile, we would like to check the inside of the lower throat, namely the larynx, to see if there is any local cause for the voice change, phlegm, and throat condition. Laryngoscopy, which we do as an office procedure, needs to be done. Do you take any medications on a regular basis for diabetes, hypertension, or thyroid problems? If sugar levels are not in control, then they can cause recurrent infection and hamper healing. In the meantime, till we get the results of the investigations, I would suggest the following medicines for you.

1) Benzydamine gargles to rinse the mouth and throat, to be done two or three times daily after meals.

2) Antacid medications, Protonix (Pantoprazole) 40 mg, one tablet to be taken twice daily before meals to remove acid reflux-associated throat irritation and reflux laryngitis.

3) Anti-inflammatory medicines: Trypsin, Chymotrypsin, and Bromelain combination, twice daily to remove any inflammation inside the throat.

4) N-Acetyl cysteine 600 mg tablet, twice daily to remove all pent-up secretions and mucus inside sinuses, as well as airways.

5) For pain, you may take Tylenol (Acetaminophen).

Consult your specialist doctor, discuss with him or her, and start taking the medicines after their consent. Get the following investigations done:

1. Total leukocyte count.

2. Differential leukocyte count.

3. Hemoglobin.

4. Fasting blood sugar.

5. Postprandial blood sugar.

6. Erythrocyte sedimentation rate.

7. Revert with more information to an ENT otolaryngologist online about the platelet count.

8. Hematocrit.

9. C-reactive protein.

10. Throat swab culture and sensitivity.

11. Phlegm for culture sensitivity and AFB (acid-fast bacilli) culture.

12. Liver function tests.

13. Kidney function tests.

14. Pure tone audiogram.

15. Tympanometry.

You do not have to read online articles and worry about your condition. Get the investigations done. Do revert for further support.

Answer 2

Hi,

Welcome back to icliniq.com.

Let us scientifically approach the issue rather than worrying about the myriad of things that the internet has to say. Do revert with the reports and doctor's suggestions. An actual visit to the otolaryngologist and his examination of the throat and ears using endoscopy cannot be substituted. In the meantime, you may start the medicines I have suggested. The medicines will not cause any harm, none of those are steroids or antibiotics. This only help to hasten recovery, remove phlegm, and inflammation. Hope to see you better soon.