Hi

Thanks for the query and an elaborate history which has made my work easier.

You seem to be suffering from sinusitis and pharyngitis.

To explain to you detail:

1. The symptoms of facial pain, mucus over the tongue, throat discomfort are all the features of sinusitis. Sinusitis is the inflammation of the paranasal sinuses causing blockage of the sinuses. Secondary to the blockage there is retention of the sinus secretions in the sinus cavities leading to facial pain, headache and pain around the eyes. Due to accumulation of the secretions in the sinuses, it gets infected and once the infected secretions pass into the back of the nose and into the throat, it causes inflammation all over the region traversed by these secretions. This inflammation in the throat is perceived as sore throat and pain at the junction of the ear and the mandible just below the ear lobe.

2. Pharyngitis (sore throat) caused secondary to trickling of the sinus secretions into the throat can give rise to pain below the jaw. This is because of two reasons (i) the lymphatic drainage of the throat is to the junction of the region below the mandible and the ear and (ii) the nerves supplying the throat has the same innervations as that of the neck hence the perception of pain.

3. The MRI, blood and the sonography results are all normal, which denotes that there is no life threatening diseases.

My suggestion to you is to do steam inhalation 3-4 times a day, this will loosen-up the secretions in the sinus and the throat, drink plenty of warm water, use saline nasal spray to keep the nasal mucosa moist and help in clearing of the nasal and sinus secretions. Also, avoid coffee, chilled and hot beverages. These above measures should take care of your problem. Do not take Aerius tablets, as this worsens your sinus related problems. Try taking mucolytics such as bromhexine or ambroxol, this helps in reducing the viscosity of the sinus secretions and your facial problems.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

1.     Im a bit confused now, because Aerius has been perscribed by the family doctor for the sinusitis and now u are telling me that I should not take it? Additionally, the Otolaryngologist told me this is def. not sinusitis but he has no idea what can cause all this pain.

A: According to the description given by you, the features seem to be of sinusitis. The same was initially diagnosed by your doctor and Aerius (Desloratidine) was prescribed. Desloratidine is an antihistaminic prescribed in allergic conditions of the nose. It causes dryness of the mucosa and makes the secretions of the nose and throat more viscid. That was the reason why I suggested you to stop Desloratidine as the viscid secretions clog the sinus opening.

Secondly, was any X-ray or CT scan of the nose and the paranasal sinuses (PNS) performed by your Otolaryngologist to rule out sinusitis? This is because, usually, in the case of sinusitis there will be either collection of the secretions or swelling of the mucosa in the sinuses, which can be confirmed with the above mentioned investigations. In my previous response I had suspected sinusitis based on the clinical features described by you.

2.     Regarding EBV and parvovirus

A: The most commonly used diagnostic criterion is the presence of 50% lymphocytes with at least 10% atypical lymphocytes (large, irregular nuclei), associated with fever, sore throat and lymphadenopathy (enlarged lymph nodes). Although the symptoms of infectious mononucleosis usually resolve in 1 or 2 months, EBV remains dormant in a few cells in the throat and blood for the rest of the person's life. A positive heterophile antibody test (monospot test) with the above mentioned symptoms can confirm the diagnosis of Infectious Mononucleosis. If you also have positive VCA-IgG, then it is highly likely that you have, or recently had, an EBV infection.

A chronic mononucleosis-like syndrome is noticed in certain individuals who experience persistent or relapsing episodes of fatigue, depression, low-grade fever, lymphadenopathy and weight loss. Actively replicating Epstein Barr Virus may be responsible for the persisting illness and fatigue associated with this viral infection.

Parvovirus B19 can affect any age group but, it is commonly seen in children aged six to ten years. Once a person has been exposed to parvovirus B19, they will have some measurable amount of IgG antibody in their blood for the rest of their life. If only parvovirus B19 IgG is present, then the person had a parvovirus infection at some time in the past and has protection against the virus, and the presence of IgM antibodies denotes that the patient may have very recently been infected. If a parvovirus B19 DNA test is positive, then the person is currently infected with parvovirus B19.

Thus the above result shows that there is no active parvovirus infection but, the possibilities of the recent EBV infection (i.e. Infectious Mononucleosis) cannot be ruled out.

As Infectious mononucleosis is generally self-limiting, only symptomatic and/or supportive treatments are used.

To conclude; CT Scan of the nose and PNS can be helpful in diagnosing your sinus related problems and to differentiate with that of EBV infection. Also, please continue with the suggestions made in my previous response.

Wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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