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Have swollen lymph node and white patches in throat. On cephalexin. Any suggestion?

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Practicing since : 1991
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Hello Dr.! I'm a 36yo male, non-smoker/very infrequent drinker, avid sportsman & fitness guy. A few weeks back I saw my pcp for what was, then, a light sensation that something was putting pressure along both sides of my Adam's apple--just a fingers width above it. He felt around and noted that I had swollen lymph nodes. He looked in my throat and immediately declared that I had strep. He said he didn't need to swab it. He also ordered blood work & urine analysis. I came back clean for all std's and kidney function.

I did have white patches in my throat, but no fever, and not much of a sore throat. 10 days on amoxicillin and the white patches were gone, but the sensation of pressure and a constant desire to clear/swallow an object remained. So I saw an ENT specialist on the 20th. He too concluded, after looking in my ears/sinuses/throat, as well as feeling around and a series if Q's, that I have swollen nodes. He said that there were no alarming sights, in all that was visible to him. He stated that sometimes infections disturb the soft tissues enough that one may require a "broad spectrum" antibiotic. So he put me on 10 days of cephalexin and said to see him again if symptoms persist at the end of those 10 days. I'm 3 days into my Rx and I'm still able to palpate what I believe to be lymph nodes (right below my jaw line, nearer to the joint) that feel about the size of my pinky nail. There also seems to be a swollen gland or something (obviously an uneducated guess) that's roughly 1.5-2 inches in length and slightly larger around than a pencil, and travels directly alongside my larynx... from the same point as those swollen nodes, yet ending just about even with my Adam's XXXXXXX It feels like the one on my right side may be more inflamed than the left. The right side also has two small "lumps" that are present at the midpoint & very bottom end. The lumps are perhaps smaller than a pea, round/smooth, mobile, and only tender if I really press then.

I'm just wondering if there may be a need to see my doctor sooner than the 7 days left on my Rx, or if my ENT guy is reasonable in his assumption/course of action?

The clearing of my throat/swallowed object sensation seems to come & go. Yesterday it had almost vanished... the day before it felt deeper--between the ends of my clavicles, today it started about mid-throat. With enough snorting and such, i can make an impact on how globus the irritation feels. I am able to get a thick clear'ish/cloudy (not XXXXXXX maybe a hint of yellow) substance to come up every now & then. It kinda feels like there's a mass of phlegm in my throat. I have very light & sporadic sinus pressure, occasional stuffy nose, no night sweats, regular sleeping habits, sometimes a little headache, good appetite, ability to eat & drink without difficulty, feel more fatigued than is typical... but not excessively so, and feel overall "normal".
Posted Wed, 12 Dec 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 3 hours later

Thank you for your query.

1. Get a USG Neck and Doppler study done. This will settle the diagnosis.

2. You seem to be responding to the treatment and recovering. Complete the course of your medication. You may add a medicated mouth wash such as Betadine or Chlorhexidine ( Peridex / Periogard), anti-inflammation and anti-allergic medication. Discuss this with your physician.

3. A Post Nasal Drip, Allergy and Acid reflux are common conditions associated with such symptoms.

4. These neck lumps are most likely reactive lymph nodes. There are about 300 lymph nodes normally present in the head and neck region. They are normally not palpable. After enlarging during inflammation or infection they rarely regress to their normal size and then can be felt (palpated) but may remain non-tender.

5. I must emphasize that there is no cause for worry.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

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